Organization
ELITE EYE CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ETHAN HUISMAN OD (PRESIDENT)
(515) 987-3937
Entity
Organization
Contact information
Practice address
1350 SE UNIVERSITY AVE, WAUKEE, IA 50263-8933
(515) 987-3937
Mailing address
1350 SE UNIVERSITY AVE, WAUKEE, IA 50263-8933
(515) 987-3937
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02216
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1266767
—
IA
Enumeration date
04/29/2010
Last updated
11/10/2021
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