Provider Demographics
NPI:1770565749
Name:GRINNELL EYE CARE PC
Entity type:Organization
Organization Name:GRINNELL EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-236-4002
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:GRINNELL
Mailing Address - State:IA
Mailing Address - Zip Code:50112-0420
Mailing Address - Country:US
Mailing Address - Phone:641-236-4002
Mailing Address - Fax:641-236-8687
Practice Address - Street 1:208 WEST ST
Practice Address - Street 2:
Practice Address - City:GRINNELL
Practice Address - State:IA
Practice Address - Zip Code:50112-2014
Practice Address - Country:US
Practice Address - Phone:641-236-4002
Practice Address - Fax:641-236-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0796748Medicaid
IA=========OtherADVANTA FREEDOM
IA=========OtherPRINCIPAL
IA=========OtherVSP
KS=========OtherUNICARE
IA=========OtherHUMANA
KS=========OtherUNICARE
IAI14781Medicare PIN
IA0339890001Medicare NSC