Mt Vernon Eye Clinic PLC
Organization Active NPI Optometrist · Mount Vernon, IA
NPI 1578635686 · NPPES record last updated Oct 29, 2008
Key facts
- NPI
- 1578635686
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- MT VERNON EYE CLINIC PLC
- Practice address
- 202 Glenn St
Mount Vernon, IA 52314-1588 - Phone
- (319) 895-8888
- Fax
- (319) 895-8889
- NPI assigned
- Nov 14, 2006
- Organization subpart
- No
Authorized official
- Name
- Peg L Flockhart
- Title
- Insurance Manager
- Phone
- (319) 895-8888
Practitioners 4
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Mt Vernon Eye Clinic PLC |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Does not accept assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322000833 | IA | Part B Supplier - Clinic/Group Practice | 2567353485 |
Receives reassigned benefits from 4 practitioners Practice locations: Mount Vernon, IA |
| O20100930058281 | IA | DME Supplier - Physician - Optometrist |
2567353485 | Practice locations: Mount Vernon, IA |
National Provider Directory
Locations
202 Glenn St SE
Mount Vernon, IA 52314
Phone (319) 895-8888
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
202 Glenn St
Mount Vernon, IA 52314-1588
Mailing address
202 Glenn St
Mount Vernon, IA 52314-1588
Phone (319) 895-8888
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0224055 | Medicaid | IA | |
| 22405 | Other | IA | BCBS |
Other providers in Mount Vernon, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.