Provider Demographics
NPI:1407038508
Name:KATHLEEN D KELTZ
Entity Type:Organization
Organization Name:KATHLEEN D KELTZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KELTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-551-1603
Mailing Address - Street 1:605 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWARDEN
Mailing Address - State:IA
Mailing Address - Zip Code:51023-2220
Mailing Address - Country:US
Mailing Address - Phone:712-551-1603
Mailing Address - Fax:712-551-1490
Practice Address - Street 1:605 9TH ST
Practice Address - Street 2:
Practice Address - City:HAWARDEN
Practice Address - State:IA
Practice Address - Zip Code:51023-2220
Practice Address - Country:US
Practice Address - Phone:712-551-1603
Practice Address - Fax:712-551-1490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01646332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
410005330OtherRAILROAD MEDICARE
SD9201220Medicaid
IA0147090Medicaid
T00891Medicare UPIN
410005330OtherRAILROAD MEDICARE
0136370001Medicare NSC