Organization
TOTAL EYE HEALTH CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK LEROY DAVIS O.D. (OWNER)
(319) 462-4891
Entity
Organization
Contact information
Practice address
603 E MAIN ST, ANAMOSA, IA 52205-1845
(319) 462-4891
(319) 462-4892
Mailing address
603 E MAIN ST, PO BOX 398, ANAMOSA, IA 52205-1845
(319) 462-4891
(319) 462-4892
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
15W00000X
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0763078
—
IA
01
—
28826
BLUE CROSS BLUE SHIELD
IA
01
—
DF8981
MEDICARE RAILROAD
IA
Enumeration date
03/21/2007
Last updated
01/30/2008
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