Provider Demographics
NPI:1831198191
Name:IOWA EYE INSTITUTE PC
Entity type:Organization
Organization Name:IOWA EYE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:D
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:712-262-8878
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:1721 W 18TH ST
Mailing Address - City:SPENCER
Mailing Address - State:IA
Mailing Address - Zip Code:51301-0420
Mailing Address - Country:US
Mailing Address - Phone:712-262-8878
Mailing Address - Fax:712-262-8807
Practice Address - Street 1:1721 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-2827
Practice Address - Country:US
Practice Address - Phone:712-262-8878
Practice Address - Fax:712-262-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0610048Medicaid
IA61004OtherWELLMARK
IA61004Medicare ID - Type Unspecified