Provider Demographics
NPI:1417692161
Name:STAKELEY, CAITLYN
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:STAKELEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 E KIMBERLY RD
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2097
Mailing Address - Country:US
Mailing Address - Phone:563-355-3912
Mailing Address - Fax:563-359-4108
Practice Address - Street 1:1718 E KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2097
Practice Address - Country:US
Practice Address - Phone:563-355-3912
Practice Address - Fax:563-359-4108
Is Sole Proprietor?:No
Enumeration Date:2022-04-27
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10432152W00000X
IA114824152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist