Organization
EYEDENTITY PC
Active
Other names
Lifetime Vision
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TARA J COOPER OD (PRESIDENT)
(515) 321-6332
Entity
Organization
Contact information
Practice address
5525 MERLE HAY RD STE 155, JOHNSTON, IA 50131-1446
(515) 321-6332
Mailing address
5525 MERLE HAY RD STE 155, JOHNSTON, IA 50131-1446
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
07/21/2011
Last updated
10/17/2011
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