Provider Demographics
NPI:1770775660
Name:KAIN FAMILY EYE CARE PC
Entity type:Organization
Organization Name:KAIN FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-354-5185
Mailing Address - Street 1:1451 CORAL RIDGE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2802
Mailing Address - Country:US
Mailing Address - Phone:319-354-5185
Mailing Address - Fax:319-354-4201
Practice Address - Street 1:1451 CORAL RIDGE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2802
Practice Address - Country:US
Practice Address - Phone:319-354-5185
Practice Address - Fax:319-354-4201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA2194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI14917Medicare PIN