Gle Glenwood LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

GLE GLENWOOD LLC

Practice address

406 1St St
Glenwood, IA 51534-1706

Phone

(712) 527-4468

Fax

(712) 527-9458

NPI assigned

Dec 9, 2022

Organization subpart

No

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

Authorized official

Name

Shawn Derene Mihulka

Title

Office Manager

Phone

(712) 520-2759

Specialties & licenses 1

Addresses

Other names 1

• Young Vision Care Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 4

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

• Dara Latner, OD

  • Optometrist
  • Glenwood, IA
  • NPI 1912564022
  Medicare reassignment Care Compare group NPD
• Kyle Klute

  • Optometrist
  • Battle Creek, MI
  • NPI 1235556804

  IA

  Medicare reassignment Care Compare group NPD
• Travis Jones, OD

  • Optometrist
  • Council Bluffs, IA
  • NPI 1720464878
  Medicare reassignment NPD
• Jacque Diane Young, OD

  • Optometrist
  • Glenwood, IA
  • NPI 1174503734
  Medicare reassignment NPD

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

{
    "created_epoch": "1670544000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1821709957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 188",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515340188",
            "telephone_number": "712-527-4468",
            "fax_number": "712-527-9458"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 1ST ST",
            "city": "GLENWOOD",
            "state": "IA",
            "postal_code": "515341706",
            "telephone_number": "712-527-4468",
            "fax_number": "712-527-9458"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLE GLENWOOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-09",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-06",
        "status": "A",
        "authorized_official_last_name": "MIHULKA",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "DERENE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "712-520-2759"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "contactus@youngvisioncare.com",
            "affiliation": "N",
            "address_1": "406 1st St",
            "city": "Glenwood",
            "state": "IA",
            "country_code": "US",
            "postal_code": "515341706",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Young Vision Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lisa Maria Fiala
• Rebecca Lee Fipps, RBT
• Five Star Quality Care-Ia, Inc.
• Chelsea Leanne Frazier
• Robert Kenneth Fryzek, M.D.
• Glen Haven Home, Inc.
• Glen Haven Home, Inc.
• Glenwood C.S.D.
• Glenwood Family Dentistry PC
• Glenwood Resource Center

• Optometrist in Glenwood, IA
• Providers in Glenwood, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2022; 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.