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801 Grand Ave Ste 350 Des Moines IA 50309-8010 | |
(515) 244-7393 | |
(515) 244-2343 |
Full Name | |
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Speciality | Clinic/Center |
Location | 801 Grand Ave Ste 350, Des Moines, Iowa |
Authorized Official Name and Position | Jeffrey L. Koenen (OPTOMETRIST/OWNER) |
Authorized Official Contact | 5152447393 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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801 Grand Ave Ste 350 Des Moines IA 50309-8010 Ph: (515) 244-7393 | 801 Grand Ave Ste 350 Des Moines IA 50309-8010 Ph: (515) 244-7393 |
NPI Number | 1851545800 |
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Provider Enumeration Date | 11/04/2008 |
Last Update Date | 11/04/2008 |
Medicare PECOS PAC ID | 6103972732 |
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Medicare Enrollment ID | O20090923000016 |
Identifier | Type | State | Issuer |
---|---|---|---|
1851545800 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | IA2072 (Iowa) | Primary |
Provider Name | Jeffrey Lynn Koenen |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1295769644 PECOS PAC ID: 3476609009 Enrollment ID: I20090923000013 |
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