Provider Demographics
NPI:1467694224
Name:KIEFER, SCOTT (LDO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:KIEFER
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 HARDING HWY
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-3513
Mailing Address - Country:US
Mailing Address - Phone:419-228-6646
Mailing Address - Fax:
Practice Address - Street 1:3225 HARDING HWY
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-3513
Practice Address - Country:US
Practice Address - Phone:419-228-6646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS5801156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician