Organization
MODERN OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VAN DB CLARK JR (OWNER)
(515) 282-8808
Entity
Organization
Contact information
Practice address
206 EUCLID AVE, DES MOINES, IA 50313-4404
(515) 282-8808
(515) 280-1182
Mailing address
206 EUCLID AVE, DES MOINES, IA 50313-4404
(515) 282-8808
(515) 280-1182
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
—
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0038307
—
IA
Enumeration date
02/28/2007
Last updated
08/22/2020
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