Provider Demographics
NPI:1245205699
Name:KJONAAS, MERLE K (OD)
Entity Type:Individual
Prefix:DR
First Name:MERLE
Middle Name:K
Last Name:KJONAAS
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 1:1060 WILLIAM ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6625
Mailing Address - Country:US
Mailing Address - Phone:319-338-9275
Mailing Address - Fax:319-338-2499
Practice Address - Street 1:1060 WILLIAM ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6625
Practice Address - Country:US
Practice Address - Phone:319-338-9275
Practice Address - Fax:319-338-2499
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01565152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0080861Medicaid
IA0080861Medicaid
T80098Medicare UPIN