Provider Demographics
NPI:1417940081
Name:STANGLER, RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:STANGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 H AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-4624
Mailing Address - Country:US
Mailing Address - Phone:319-362-9855
Mailing Address - Fax:319-362-0655
Practice Address - Street 1:1136 H AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-4624
Practice Address - Country:US
Practice Address - Phone:319-362-9855
Practice Address - Fax:319-362-0655
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2011-01-04
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
IA33112207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0196980Medicaid
CC8734OtherRAILRAOD MEDICARE
IA07591OtherWELLMARK BCBS
5265807OtherAETNA KOEKWELL
IA04855OtherWELLMARK BCBS
IA42137562808OtherJOHN DEERE
IA0196980Medicaid
IA42137562808OtherJOHN DEERE