Provider Demographics
NPI:1073578217
Name:RHOADS, KRISTIN KAYE (OD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:KAYE
Last Name:RHOADS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208
Mailing Address - Country:US
Mailing Address - Phone:641-792-7900
Mailing Address - Fax:641-792-8663
Practice Address - Street 1:100 N 4TH AVE W
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208
Practice Address - Country:US
Practice Address - Phone:641-792-7900
Practice Address - Fax:641-792-8663
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA19525OtherGROUP BCBS
IA2165597Medicaid
IA40180OtherBCBS
IA0195255Medicaid
IA40180OtherBCBS
U66517Medicare UPIN
IA19525Medicare ID - Type UnspecifiedGROUP