NPIMap

Organization Active NPI

Elite Eye Care PC

  • Optometrist
  • Waukee, IA
National Provider Identifier
1700103850
Registry record updated Nov 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
02216 Issued in IA
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
Last updated
Nov 10, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ethan Huisman, ODNPI 1891776365
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)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 Directory

Locations

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, and the practitioner matching its NPPES authorized official.

View all 13

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": [],
    "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.

Verify at the official NPI Registry.