Active NPI
Elite Eye Care PC
- Optometrist
- Waukee, IA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 02216
- Legal business name
- ELITE EYE CARE PC
- Practice address
- 1350 SE University Ave
Waukee, IA 50263-8933 - Phone
- (515) 987-3937
- NPI assigned
- Apr 29, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Ethan Huisman, OD
- Title
- President
- Phone
- (515) 987-3937
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 02216 | IA | Primary |
Addresses
Primary practice location
1350 SE University Ave
Waukee, IA 50263-8933
Mailing address
1350 SE University Ave
Waukee, IA 50263-8933
Phone (515) 987-3937
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1266767 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100728001132 | IA | Part B Supplier - Clinic/Group Practice | 0446383327 |
Receives reassigned benefits from 11 practitioners Practice locations: Waukee, IA; Ankeny, IA; Norwalk, IA |
National Provider Directory
National Provider DirectoryLocations
1810 SW White Birch Cir
Ste 109
Ankeny, IA 50023
Phone (515) 965-8488
1350 SE University Ave
Waukee, IA 50263
Phone (515) 987-3937
9250 University Ave
Unit 110
West Des Moines, IA 50266
Phone (515) 987-3937
Practitioners & affiliated clinicians
Practitioners 13
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Webster City, IA
- NPI 1821343484
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272499200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1636502400000",
"number": "1700103850",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1350 SE UNIVERSITY AVE",
"city": "WAUKEE",
"state": "IA",
"postal_code": "502638933",
"telephone_number": "515-987-3937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1350 SE UNIVERSITY AVE",
"city": "WAUKEE",
"state": "IA",
"postal_code": "502638933",
"telephone_number": "515-987-3937"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ELITE EYE CARE PC",
"organizational_subpart": "NO",
"enumeration_date": "2010-04-29",
"last_updated": "2021-11-10",
"certification_date": "2021-11-10",
"status": "A",
"authorized_official_last_name": "HUISMAN",
"authorized_official_first_name": "ETHAN",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "515-987-3937",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "IA",
"license": "02216",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1266767",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waukee, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.