Provider Demographics
NPI:1427234582
Name:HARLAN VISION CLINIC, P.C.
Entity type:Organization
Organization Name:HARLAN VISION CLINIC, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:MCCUTCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-755-3893
Mailing Address - Street 1:2306 12TH ST
Mailing Address - Street 2:
Mailing Address - City:HARLAN
Mailing Address - State:IA
Mailing Address - Zip Code:51537-2002
Mailing Address - Country:US
Mailing Address - Phone:712-755-3893
Mailing Address - Fax:712-755-7580
Practice Address - Street 1:2306 12TH ST
Practice Address - Street 2:
Practice Address - City:HARLAN
Practice Address - State:IA
Practice Address - Zip Code:51537-2002
Practice Address - Country:US
Practice Address - Phone:712-755-3893
Practice Address - Fax:712-755-7580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03292OtherBLUE CROSS/WELLMARK
IA0032920Medicaid
IA410015661OtherRAILROAD MEDICARE
IA03292Medicare PIN
IA03292OtherBLUE CROSS/WELLMARK
IAT00386Medicare UPIN