Organization
HALSTED'S PC
Active
Other names
Groetken Family Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH KAY GROETKEN OD (OWNER/DOCTOR)
(712) 546-8998
Entity
Organization
Contact information
Practice address
16 CENTRAL AVE NE, LE MARS, IA 51031-3515
(712) 454-6899
(712) 546-8971
Mailing address
16 CENTRAL AVE NE, LE MARS, IA 51031-3515
(712) 546-8998
(712) 546-8971
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02144
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0135230002
MEDICARE CIGNA
IA
01
—
11206
MIDLANDS
IA
01
—
1760436802
NPI PROVIDER
IA
05
—
2195669
—
IA
01
—
28406
BCBS OF IOWA
IA
Enumeration date
11/21/2007
Last updated
05/22/2008
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