Provider Demographics
NPI:1043282148
Name:FUERSTE EYE CLINIC
Entity type:Organization
Organization Name:FUERSTE EYE CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FUERSTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-582-7167
Mailing Address - Street 1:2140 JFK RD
Mailing Address - Street 2:STE F
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52002-3883
Mailing Address - Country:US
Mailing Address - Phone:563-582-7167
Mailing Address - Fax:563-582-5772
Practice Address - Street 1:2140 JFK RD
Practice Address - Street 2:STE F
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52002-3883
Practice Address - Country:US
Practice Address - Phone:563-582-7167
Practice Address - Fax:563-582-5772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10510OtherBCBS ID NUMBER