NPIMap

Organization Active NPI

Eyecare Centre

  • Optometrist
  • Spirit Lake, IA
National Provider Identifier
1750315040
Registry record updated Aug 26, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
02082 Issued in IA
Legal business name
EYECARE CENTRE
Practice address
2312 23Rd Street
Spirit Lake, IA 51360-0328
Phone
(712) 336-1960
NPI assigned
Jul 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2008

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

Authorized official

Name
Dr. Randy Franklin Cornwall, ODNPI 1619901550
Title
Partner
Phone
(712) 336-1960

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 02082 IA Primary
OptometristGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 152W00000X 01903 IA

Addresses

Primary practice location

2312 23Rd Street
Spirit Lake, IA 51360-0328

Mailing address

2312 23Rd Street
PO Box Ag
Spirit Lake, IA 51360-0328
Phone (712) 336-1960

Other identifiers 5

IdentifierTypeStateIssuer
0286104MedicaidIA
29415OtherIAGROUP WELLMARK BCBS
1162032MedicaidIA
28610OtherIADR. N WELLMARK BCBS
40832OtherIADR. C. WELLMARK BCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040210000768 IA Part B Supplier - Clinic/Group Practice 1951295047 Receives reassigned benefits from 5 practitioners
2 other NPIs on this enrollment
Practice locations: Spencer, IA; Spirit Lake, IA; Estherville, IA
O20100930055592 IA DME Supplier - Physician - OptometristDME Supplier - Optician 1951295047 Practice locations: Spirit Lake, IA

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2190313Eyecare Centre2312 23Rd St, Spirit Lake, IA 51360Certificate of waiverAug 11, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Eyecare Centre2312 23Rd St, Spirit Lake, IA 51360-1044(712) 336-1960 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Stephen Rose OD3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219708800000",
    "number": "1750315040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2312 23RD STREET",
            "address_2": "PO BOX AG",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513600328",
            "telephone_number": "712-336-1960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2312 23RD STREET",
            "city": "SPIRIT LAKE",
            "state": "IA",
            "postal_code": "513600328",
            "telephone_number": "712-336-1960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYECARE CENTRE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-08-26",
        "status": "A",
        "authorized_official_last_name": "CORNWALL",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "FRANKLIN",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "712-336-1960",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02082",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01903",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0286104",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP WELLMARK BCBS",
            "identifier": "29415",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1162032",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. N WELLMARK BCBS",
            "identifier": "28610",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. C. WELLMARK BCBS",
            "identifier": "40832",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spirit Lake, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.