Provider Demographics
NPI:1932356680
Name:EYEOWA OPTICAL COMPANY
Entity Type:Organization
Organization Name:EYEOWA OPTICAL COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GENKINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-472-6694
Mailing Address - Street 1:122 N COURT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52556-2815
Mailing Address - Country:US
Mailing Address - Phone:641-472-6694
Mailing Address - Fax:641-472-5979
Practice Address - Street 1:122 N COURT ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:IA
Practice Address - Zip Code:52556-2815
Practice Address - Country:US
Practice Address - Phone:641-472-6694
Practice Address - Fax:641-472-5979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0263418Medicaid
IA26341Medicare PIN
IA0541710001Medicare NSC