Provider Demographics
NPI:1104874643
Name:BAUMHOVER, KELLEY S (OD)
Entity type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:S
Last Name:BAUMHOVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KELLEY
Other - Middle Name:
Other - Last Name:SCHWARTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:5901 WESTOWN PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-8207
Mailing Address - Country:US
Mailing Address - Phone:515-225-3546
Mailing Address - Fax:515-224-5946
Practice Address - Street 1:5901 WESTOWN PKWY STE 200
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-8207
Practice Address - Country:US
Practice Address - Phone:515-225-3546
Practice Address - Fax:515-224-5946
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019595152W00000X
IA02485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO319115903Medicaid
MO192152OtherBLUE CROSS/SHIELD
166876OtherHEALTHLINK
IAIA19629Medicaid
MOP00288693Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MO319115903Medicaid