Provider Demographics
NPI:1215460910
Name:POLK CITY EYECARE INC
Entity type:Organization
Organization Name:POLK CITY EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRACI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-329-6454
Mailing Address - Street 1:905 WEST BRIDGE ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:POLK CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50226-2254
Mailing Address - Country:US
Mailing Address - Phone:515-329-6454
Mailing Address - Fax:515-984-3436
Practice Address - Street 1:905 WEST BRIDGE ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:POLK CITY
Practice Address - State:IA
Practice Address - Zip Code:50226-2254
Practice Address - Country:US
Practice Address - Phone:515-329-6454
Practice Address - Fax:515-984-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty