Provider Demographics
NPI:1821144916
Name:KIEFIUK, WILLIAM JOHN (OD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:KIEFIUK
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 1:5016 WAVEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COMMERCE TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48382-1362
Mailing Address - Country:US
Mailing Address - Phone:248-249-4793
Mailing Address - Fax:734-853-3798
Practice Address - Street 1:22320 GODDARD RD
Practice Address - Street 2:SVS
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180
Practice Address - Country:US
Practice Address - Phone:734-287-3311
Practice Address - Fax:734-759-3092
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U80901Medicare UPIN
MION75280Medicare ID - Type Unspecified