Provider Demographics
NPI:1306023551
Name:DONALD J KINGFIELD
Entity type:Organization
Organization Name:DONALD J KINGFIELD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINGFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-295-3743
Mailing Address - Street 1:220 N DODGE ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-2405
Mailing Address - Country:US
Mailing Address - Phone:515-295-3743
Mailing Address - Fax:515-295-2653
Practice Address - Street 1:220 N DODGE ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-2405
Practice Address - Country:US
Practice Address - Phone:515-295-3743
Practice Address - Fax:515-295-2653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1503332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0263200001Medicare NSC