Provider Demographics
NPI:1821288457
Name:WENDELL F. STOELTING OD PC
Entity Type:Organization
Organization Name:WENDELL F. STOELTING OD PC
Other - Org Name:DR. WENDELL F. STOELTING
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:F
Authorized Official - Last Name:STOELTING
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-225-3822
Mailing Address - Street 1:215 W. WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:CHEROKEE
Mailing Address - State:IA
Mailing Address - Zip Code:51012-1856
Mailing Address - Country:US
Mailing Address - Phone:712-225-3822
Mailing Address - Fax:712-225-5395
Practice Address - Street 1:215 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:CHEROKEE
Practice Address - State:IA
Practice Address - Zip Code:51012-1856
Practice Address - Country:US
Practice Address - Phone:712-225-3822
Practice Address - Fax:712-225-5395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1569152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0446377Medicaid
CI5976OtherRAILROAD MEDICARE
IAI7857Medicare PIN
CI5976OtherRAILROAD MEDICARE