Provider Demographics
NPI:1063537587
Name:CHRIS K DENOUDEN, D.O., P.C.
Entity type:Organization
Organization Name:CHRIS K DENOUDEN, D.O., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:DENOUDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-266-5353
Mailing Address - Street 1:1300 DES MOINES ST
Mailing Address - Street 2:STE 103
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-5502
Mailing Address - Country:US
Mailing Address - Phone:515-266-5353
Mailing Address - Fax:515-266-2216
Practice Address - Street 1:1300 DES MOINES ST
Practice Address - Street 2:STE 103
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-5502
Practice Address - Country:US
Practice Address - Phone:515-266-5353
Practice Address - Fax:515-266-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01711207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0193847Medicaid
IA19384Medicare ID - Type Unspecified
IA1063537587Medicare NSC
IAA01973Medicare UPIN