Provider Demographics
NPI:1023187184
Name:WJC LTD
Entity type:Organization
Organization Name:WJC LTD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCH
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-338-9381
Mailing Address - Street 1:2056 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-1502
Mailing Address - Country:US
Mailing Address - Phone:319-338-9381
Mailing Address - Fax:319-466-4662
Practice Address - Street 1:2056 8TH STREET
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-1502
Practice Address - Country:US
Practice Address - Phone:319-338-9381
Practice Address - Fax:319-466-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA51671OtherBCBS OF IOWA
IA42253OtherDAVIS VISION