Provider Demographics
NPI:1760436802
Name:GROETKEN, ELIZABETH KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KAY
Last Name:GROETKEN
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 1:16 CENTRAL AVE NE
Mailing Address - Street 2:PO BOX 706
Mailing Address - City:LE MARS
Mailing Address - State:IA
Mailing Address - Zip Code:51031-3515
Mailing Address - Country:US
Mailing Address - Phone:712-546-8998
Mailing Address - Fax:
Practice Address - Street 1:16 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:LE MARS
Practice Address - State:IA
Practice Address - Zip Code:51031-3515
Practice Address - Country:US
Practice Address - Phone:712-546-8998
Practice Address - Fax:712-546-8971
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA28406OtherBCBS
IA11206OtherMIDLANDS
IA0135230002OtherCIGNA MEDICARE
IA2195669Medicaid
IA11206OtherMIDLANDS
IAI20045Medicare PIN