Provider Demographics
NPI:1881757326
Name:OPTIX EYE DESIGN INC
Entity type:Organization
Organization Name:OPTIX EYE DESIGN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOWE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-866-9190
Mailing Address - Street 1:2740 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4856
Mailing Address - Country:US
Mailing Address - Phone:319-866-9190
Mailing Address - Fax:319-866-9192
Practice Address - Street 1:2740 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4856
Practice Address - Country:US
Practice Address - Phone:319-866-9190
Practice Address - Fax:319-866-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152-02193152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA5899170001Medicare NSC
IAI19362Medicare PIN