Provider Demographics
NPI:1770555971
Name:MORAN EYE CENTER PC
Entity type:Organization
Organization Name:MORAN EYE CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:F
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:712-252-4333
Mailing Address - Street 1:2001 HAMILTON BLVD
Mailing Address - Street 2:STE D
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104
Mailing Address - Country:US
Mailing Address - Phone:712-252-4333
Mailing Address - Fax:712-252-1633
Practice Address - Street 1:2001 HAMILTON BLVD
Practice Address - Street 2:STE D
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104
Practice Address - Country:US
Practice Address - Phone:712-252-4333
Practice Address - Fax:712-252-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19909261QM2500X
IA25860207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0244913Medicaid
NE=========00Medicaid
A03241Medicare UPIN
NE=========00Medicaid
NE275294Medicare PIN
IA25644Medicare PIN
NE099174Medicare PIN