Basic Information
| Provider Information | |||||||||
| NPI: | 1174840474 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UNIVERSITY OF IOWA COMMUNITY MEDICAL SERVICES INC | ||||||||
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| OtherOrganizationName: | UI HEALTH CARE - RIVER CROSSING OPTICAL SHOP | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2941 SIERRA CT SW | ||||||||
| Address2: | |||||||||
| City: | IOWA CITY | ||||||||
| State: | IA | ||||||||
| PostalCode: | 522408503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3193377642 | ||||||||
| FaxNumber: | 3193391449 | ||||||||
| Practice Location | |||||||||
| Address1: | 3056 RIVER CROSSING COURT | ||||||||
| Address2: | SUITE B | ||||||||
| City: | RIVERSIDE | ||||||||
| State: | IA | ||||||||
| PostalCode: | 523274727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3194678335 | ||||||||
| FaxNumber: | 3194678337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 04/28/2010 | ||||||||
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| AuthorizedOfficialLastName: | PROTEXTOR | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3193377642 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
No ID Information.