Provider Demographics
NPI:1538436761
Name:TAYLOR VISION PC
Entity type:Organization
Organization Name:TAYLOR VISION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-325-4544
Mailing Address - Street 1:928 VALLEY VIEW DR STE 17
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5288
Mailing Address - Country:US
Mailing Address - Phone:712-256-8898
Mailing Address - Fax:712-256-0419
Practice Address - Street 1:928 VALLEY VIEW DR STE 17
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-5288
Practice Address - Country:US
Practice Address - Phone:712-256-8898
Practice Address - Fax:712-256-0419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-16
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2508152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty