Provider Demographics
NPI:1588787691
Name:VISION CENTER OF DEWITT P C
Entity type:Organization
Organization Name:VISION CENTER OF DEWITT P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-659-3999
Mailing Address - Street 1:800 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:IA
Mailing Address - Zip Code:52742-1329
Mailing Address - Country:US
Mailing Address - Phone:563-659-3999
Mailing Address - Fax:563-659-2966
Practice Address - Street 1:800 6TH AVE
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:IA
Practice Address - Zip Code:52742-1329
Practice Address - Country:US
Practice Address - Phone:563-659-3999
Practice Address - Fax:563-659-2966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI3188Medicare PIN
IA5021140001Medicare NSC