Provider Demographics
NPI:1881719474
Name:DR DOUGLAS C KIEFER & ASSOCIATES PC.
Entity type:Organization
Organization Name:DR DOUGLAS C KIEFER & ASSOCIATES PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:970-226-0540
Mailing Address - Street 1:5943 SKY POND DR, UNIT E100
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:970-667-1866
Mailing Address - Fax:970-667-7826
Practice Address - Street 1:5943 SKY POND DR, UNIT E100
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538
Practice Address - Country:US
Practice Address - Phone:970-667-1866
Practice Address - Fax:970-667-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1268152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU29819Medicare UPIN
COU29819Medicare UPIN