Organization
EYECARE CENTRE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RANDY FRANKLIN CORNWALL OD (PARTNER)
(712) 336-1960
Entity
Organization
Contact information
Practice address
2312 23RD STREET, SPIRIT LAKE, IA 51360-0328
(712) 336-1960
Mailing address
2312 23RD STREET, PO BOX AG, SPIRIT LAKE, IA 51360-0328
(712) 336-1960
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
01903
IA
152W00000X
Optometrist
Primary
02082
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0286104
—
IA
05
—
1162032
—
IA
01
—
28610
DR. N WELLMARK BCBS
IA
01
—
29415
GROUP WELLMARK BCBS
IA
01
—
40832
DR. C. WELLMARK BCBS
IA
Enumeration date
07/10/2006
Last updated
08/26/2008
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