Provider Demographics
NPI:1306056510
Name:ANKENY FAMILY VISION CENTER PC
Entity type:Organization
Organization Name:ANKENY FAMILY VISION CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:HANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-964-1671
Mailing Address - Street 1:311 N ANKENY BLVD
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-1711
Mailing Address - Country:US
Mailing Address - Phone:515-964-1671
Mailing Address - Fax:
Practice Address - Street 1:311 N ANKENY BLVD
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-1711
Practice Address - Country:US
Practice Address - Phone:515-964-1671
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01592152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1295730992OtherNPI TYPE I NUMBER
IA01592OtherIOWA LICENSE NUMBER
IA1142968Medicaid
IA$$$$$$$$$OtherDOCTORS SOCIAL
IADE6338OtherRAIL ROAD MEDICARE
IADE6338OtherRAIL ROAD MEDICARE
IADE6338OtherRAIL ROAD MEDICARE
IA5648350001Medicare NSC
IADE6338OtherRAIL ROAD MEDICARE
IA479643774OtherDOCTORS SOCIAL