Provider Demographics
NPI:1447553474
Name:WASHINGTON EYE CARE CENTER
Entity type:Organization
Organization Name:WASHINGTON EYE CARE CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-653-4558
Mailing Address - Street 1:221 N 2ND AVE
Mailing Address - Street 2:BOX 70
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-2203
Mailing Address - Country:US
Mailing Address - Phone:319-653-4558
Mailing Address - Fax:319-653-2574
Practice Address - Street 1:221 N 2ND AVE
Practice Address - Street 2:BOX 70
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-2203
Practice Address - Country:US
Practice Address - Phone:319-653-4558
Practice Address - Fax:319-653-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2015T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6473820001Medicare NSC
IAIB2078Medicare PIN