Provider Demographics
NPI:1306807821
Name:KIEFER, DOUGLAS C (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:C
Last Name:KIEFER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5943 SKY POND DR
Mailing Address - Street 2:UNIT E100
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9026
Mailing Address - Country:US
Mailing Address - Phone:970-226-0540
Mailing Address - Fax:970-282-7780
Practice Address - Street 1:5943 SKY POND DR UNIT E100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9026
Practice Address - Country:US
Practice Address - Phone:970-667-1866
Practice Address - Fax:970-667-7826
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU21819Medicare UPIN
CO533278Medicare ID - Type Unspecified