Eyewear Gallery
Organization Active NPI Optometrist · De Witt, IA
NPI 1588029938 · NPPES record last updated Dec 29, 2015
Key facts
- NPI
- 1588029938
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 073412 (IA)
- Legal business name
- EYEWEAR GALLERY
- Practice address
- 1107 9TH Ave
De Witt, IA 52742-1053 - Phone
- (563) 659-2020
- Fax
- (563) 659-2121
- NPI assigned
- Dec 29, 2015
- Organization subpart
- No
Authorized official
- Name
- Ms. Susan Y Briggs
- Title
- Office Manager
- Phone
- (563) 659-2020
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Practitioners 2
-
Mark Allen Benson, O.D.
-
Jacob M. Hayward, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160128002098 | IA | Part B Supplier - Clinic/Group Practice | 0042513848 |
Receives reassigned benefits from 2 practitioners Practice locations: Dewitt, IA |
| O20160629001034 | IA | DME Supplier - Physician - Optometrist | 0042513848 | Practice locations: De Witt, IA |
National Provider Directory
- Tax ID family
- Eyewear Gallery
Locations
1107 9th Ave
De Witt, IA 52742
Phone (563) 659-2020
101 N Main St
Maquoketa, IA 52060
Phone (406) 851-1100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 073412 | IA | Yes |
Addresses
Primary practice location
1107 9TH Ave
De Witt, IA 52742-1053
Mailing address
PO Box 50
De Witt, IA 52742-0050
Phone (563) 659-2020
Other names
- DEWITT EYECARE
Other providers in De Witt, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 29, 2015. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.