Provider Demographics
NPI:1477545697
Name:SCHRUNK, KEITH A (OD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:SCHRUNK
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 1:201 N MAIN ST
Mailing Address - Street 2:BOX 399
Mailing Address - City:DENISON
Mailing Address - State:IA
Mailing Address - Zip Code:51442-0399
Mailing Address - Country:US
Mailing Address - Phone:712-263-2020
Mailing Address - Fax:712-263-4053
Practice Address - Street 1:201 N MAIN ST
Practice Address - Street 2:BOX 399
Practice Address - City:DENISON
Practice Address - State:IA
Practice Address - Zip Code:51442-0399
Practice Address - Country:US
Practice Address - Phone:712-263-2020
Practice Address - Fax:712-263-4053
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA02260152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA021339Medicaid
421497917OtherCOMMERCIAL & OTHER STATES
IA18020OtherWELLMARK
IAA004235OtherCHAMPUS
IAA004235OtherCHAMPUS
IA021339Medicaid
IA4001120003Medicare NSC
IACH2873Medicare PIN