Provider Demographics
NPI:1912065095
Name:MEDICAL ARTS EYECARE, PLC
Entity Type:Organization
Organization Name:MEDICAL ARTS EYECARE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-573-1145
Mailing Address - Street 1:1428 2ND AVE N
Mailing Address - Street 2:
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-4119
Mailing Address - Country:US
Mailing Address - Phone:515-573-1145
Mailing Address - Fax:515-573-1028
Practice Address - Street 1:1428 2ND AVE N
Practice Address - Street 2:
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-4119
Practice Address - Country:US
Practice Address - Phone:515-573-1145
Practice Address - Fax:515-573-1028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01536152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA07134OtherRY JACOBSON, O.D BCBS
IA3066183Medicaid
IA0000389Medicaid
IA38024OtherPA LENANE, O.D. BCBS
IAIB1233002OtherMEDICARE ID - TYPE UNSPECIFIED
IAIB1233003OtherMEDICARE ID
IA5145540Medicaid
IAIB1233OtherMEDICARE ID - TYPE UNSPECIFIED
IAIB1233001OtherMEDICARE ID - TYPE UNSPECIFIED
IA0000389Medicaid
IA07134OtherRY JACOBSON, O.D BCBS
IA38024OtherPA LENANE, O.D. BCBS
IAIB1233OtherMEDICARE ID - TYPE UNSPECIFIED
IAU63389Medicare UPIN
IA6153780001Medicare NSC