Provider Demographics
NPI:1497741201
Name:STOELTING, WENDELL F (OD)
Entity Type:Individual
Prefix:DR
First Name:WENDELL
Middle Name:F
Last Name:STOELTING
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 1:215 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1856
Mailing Address - Country:US
Mailing Address - Phone:712-225-3822
Mailing Address - Fax:712-225-5395
Practice Address - Street 1:215 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1856
Practice Address - Country:US
Practice Address - Phone:712-225-3822
Practice Address - Fax:712-225-5395
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0093526Medicaid
IA410017407OtherRAILROAD MEDICARE
IA0173490001Medicare NSC
IA09325Medicare PIN
IA410017407OtherRAILROAD MEDICARE