Provider Demographics
NPI:1104859065
Name:STIGGE, DOUGLAS KENT (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KENT
Last Name:STIGGE
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 1:1202 MORO ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5353
Mailing Address - Country:US
Mailing Address - Phone:785-539-6051
Mailing Address - Fax:785-539-6074
Practice Address - Street 1:1202 MORO ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5353
Practice Address - Country:US
Practice Address - Phone:785-539-6051
Practice Address - Fax:785-539-6074
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1161-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100091190AMedicaid
KS480922478OtherTRI-CARE
KS704711 PAYER #90060OtherFIRST GUARD
KS100091190BMedicaid
KS049680Medicare ID - Type UnspecifiedMANHATTAN OFFICE
KS704711 PAYER #90060OtherFIRST GUARD
KS100091190BMedicaid
KS480922478OtherTRI-CARE