Provider Demographics
NPI:1447495379
Name:ECKHART & WITTROCK, PLC
Entity type:Organization
Organization Name:ECKHART & WITTROCK, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER PLC
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WITTROCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-360-5636
Mailing Address - Street 1:6630 MILLS CIVIC PKWY
Mailing Address - Street 2:SUITE 6120
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8285
Mailing Address - Country:US
Mailing Address - Phone:515-225-6447
Mailing Address - Fax:515-226-2347
Practice Address - Street 1:6630 MILLS CIVIC PKWY
Practice Address - Street 2:SUITE 6120
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8285
Practice Address - Country:US
Practice Address - Phone:515-225-6447
Practice Address - Fax:515-226-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002409152W00000X
IA02204152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty