Organization
ADVANCED EYE HEALTH
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. REBECCA DERUYTER OD (OWNER)
(712) 546-6868
Entity
Organization
Contact information
Practice address
1111 HOLTON DR, LE MARS, IA 51031-2884
(712) 546-6868
(712) 546-6739
Mailing address
1111 HOLTON DR, LE MARS, IA 51031-2884
(712) 546-6868
(712) 546-6739
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02253
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
02253
LICENSE
IA
Enumeration date
06/25/2010
Last updated
06/25/2010
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