Provider Demographics
NPI:1518077940
Name:KUNZMAN, JILL N (OD)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:N
Last Name:KUNZMAN
Suffix:
Gender:F
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:PO BOX 409
Mailing Address - Street 2:
Mailing Address - City:SHELDON
Mailing Address - State:IA
Mailing Address - Zip Code:51201-0409
Mailing Address - Country:US
Mailing Address - Phone:712-324-5151
Mailing Address - Fax:712-324-5036
Practice Address - Street 1:228 9TH ST
Practice Address - Street 2:
Practice Address - City:SIBLEY
Practice Address - State:IA
Practice Address - Zip Code:51249-1801
Practice Address - Country:US
Practice Address - Phone:712-754-4621
Practice Address - Fax:712-754-2762
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0268052Medicaid
IA1268052Medicaid
IAI8073Medicare ID - Type Unspecified
IA1268052Medicaid