Provider Demographics
NPI:1548631732
Name:INDIANHEAD INVESTMENTS, LLC
Entity type:Organization
Organization Name:INDIANHEAD INVESTMENTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-520-3952
Mailing Address - Street 1:62859 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-7984
Mailing Address - Country:US
Mailing Address - Phone:515-520-3952
Mailing Address - Fax:
Practice Address - Street 1:10 TAFT ST S
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-2037
Practice Address - Country:US
Practice Address - Phone:515-332-2950
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-13
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty