Provider Demographics
NPI:1699089078
Name:MP EYECARE, LLC
Entity type:Organization
Organization Name:MP EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:POLLASTRINI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-240-4173
Mailing Address - Street 1:1215 AMELIA DR
Mailing Address - Street 2:#4
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50613-7982
Mailing Address - Country:US
Mailing Address - Phone:319-240-4173
Mailing Address - Fax:
Practice Address - Street 1:105 20TH ST NW
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:IA
Practice Address - Zip Code:50677-2059
Practice Address - Country:US
Practice Address - Phone:319-352-4516
Practice Address - Fax:319-352-0291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1856Medicare PIN