Provider Demographics
NPI:1720017411
Name:STIGGE VISION CARE
Entity Type:Organization
Organization Name:STIGGE VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:STIGGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:785-539-6051
Mailing Address - Street 1:1202 MORO ST
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-5353
Mailing Address - Country:US
Mailing Address - Phone:785-539-6051
Mailing Address - Fax:785-539-6074
Practice Address - Street 1:1202 MORO ST
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-5353
Practice Address - Country:US
Practice Address - Phone:785-539-6051
Practice Address - Fax:785-539-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1161-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0170850001Medicare NSC