Provider Demographics
NPI:1053362863
Name:OPTOMETRIC ASSOCIATES OF WARREN COUNTY PC
Entity type:Organization
Organization Name:OPTOMETRIC ASSOCIATES OF WARREN COUNTY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:A
Authorized Official - Last Name:WINJUM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-989-0889
Mailing Address - Street 1:55 SCHOOL ST
Mailing Address - Street 2:BOX 265
Mailing Address - City:CARLISLE
Mailing Address - State:IA
Mailing Address - Zip Code:50047-8782
Mailing Address - Country:US
Mailing Address - Phone:515-989-0889
Mailing Address - Fax:515-989-9348
Practice Address - Street 1:55 SCHOOL ST
Practice Address - Street 2:BOX 265
Practice Address - City:CARLISLE
Practice Address - State:IA
Practice Address - Zip Code:50047-8782
Practice Address - Country:US
Practice Address - Phone:515-989-0889
Practice Address - Fax:515-989-9348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0115121Medicaid
IA0115121Medicaid
IA0354030001Medicare NSC