Provider Demographics
NPI:1295723633
Name:DUGGER, KRISTIAN LEE (OD)
Entity type:Individual
Prefix:DR
First Name:KRISTIAN
Middle Name:LEE
Last Name:DUGGER
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 1:1018 6TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NEVADA
Mailing Address - State:IA
Mailing Address - Zip Code:50201-1826
Mailing Address - Country:US
Mailing Address - Phone:515-382-5471
Mailing Address - Fax:515-382-5621
Practice Address - Street 1:1018 6TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NEVADA
Practice Address - State:IA
Practice Address - Zip Code:50201-1826
Practice Address - Country:US
Practice Address - Phone:515-382-4626
Practice Address - Fax:515-382-4979
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02031152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0169136Medicaid
IAU70006Medicare UPIN
IAI21881Medicare PIN