Provider Demographics
NPI:1811947849
Name:COURTNEY EYE CARE, P.C.
Entity type:Organization
Organization Name:COURTNEY EYE CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-785-4497
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:IA
Mailing Address - Zip Code:52747-0037
Mailing Address - Country:US
Mailing Address - Phone:563-785-4497
Mailing Address - Fax:563-785-4607
Practice Address - Street 1:409 8TH AVE
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:IA
Practice Address - Zip Code:52747
Practice Address - Country:US
Practice Address - Phone:563-785-4497
Practice Address - Fax:563-785-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0465294Medicaid
IA0465294Medicaid
IAI15327Medicare ID - Type Unspecified
IA5648230001Medicare NSC