Provider Demographics
NPI:1093867574
Name:ELKADER EYE CARE, PC
Entity type:Organization
Organization Name:ELKADER EYE CARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:WOODLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-875-0006
Mailing Address - Street 1:202 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKADER
Mailing Address - State:IA
Mailing Address - Zip Code:52043-9078
Mailing Address - Country:US
Mailing Address - Phone:563-875-0006
Mailing Address - Fax:563-875-7874
Practice Address - Street 1:202 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9078
Practice Address - Country:US
Practice Address - Phone:563-245-2304
Practice Address - Fax:563-245-2392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID0069633Medicaid
IACD7104Medicare PIN
ID0069633Medicaid
IA0311940001Medicare NSC