Provider Demographics
NPI:1447349279
Name:AMERICAN EYECARE PC
Entity type:Organization
Organization Name:AMERICAN EYECARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JENNINGS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-754-2020
Mailing Address - Street 1:2025 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-3225
Mailing Address - Country:US
Mailing Address - Phone:319-524-2020
Mailing Address - Fax:319-524-4148
Practice Address - Street 1:2025 MAIN ST
Practice Address - Street 2:
Practice Address - City:KEOKUK
Practice Address - State:IA
Practice Address - Zip Code:52632-3225
Practice Address - Country:US
Practice Address - Phone:319-524-2020
Practice Address - Fax:319-524-4148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1667152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IACE7235OtherRR MEDICARE
IA0080523Medicaid
IACE7235OtherRR MEDICARE
IA0150000002Medicare NSC