Provider Demographics
NPI:1619182219
Name:KINGUS, ROBERT THOMAS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:KINGUS
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 1:5350 KIRKWOOD BLVD SW
Mailing Address - Street 2:STE 100
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52404-5233
Mailing Address - Country:US
Mailing Address - Phone:319-365-2946
Mailing Address - Fax:319-365-2948
Practice Address - Street 1:5350 KIRKWOOD BLVD SW STE 100
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52404-5233
Practice Address - Country:US
Practice Address - Phone:319-365-2946
Practice Address - Fax:319-365-2948
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02352152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist