Provider Demographics
NPI:1730265117
Name:FETTERS FAMILY EYE CARE PC
Entity type:Organization
Organization Name:FETTERS FAMILY EYE CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:M
Authorized Official - Last Name:FETTERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-390-4144
Mailing Address - Street 1:3726 QUEEN CT SW STE 201
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-3906
Mailing Address - Country:US
Mailing Address - Phone:319-826-6691
Mailing Address - Fax:319-826-6694
Practice Address - Street 1:3726 QUEEN CT SW STE 201
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-3906
Practice Address - Country:US
Practice Address - Phone:319-390-4144
Practice Address - Fax:319-390-4674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI15982Medicare PIN
IAI15982001Medicare PIN
IAI15981Medicare PIN