NPIMap

Organization Active NPI

Kathleen D Keltz

  • Eyewear Supplier
  • Hawarden, IA
National Provider Identifier
1407038508
Registry record updated Dec 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
License
01646 Issued in IA
Legal business name
KATHLEEN D KELTZ
Practice address
605 9TH St
Hawarden, IA 51023-2220
Phone
(712) 551-1603
Fax
(712) 551-1490
NPI assigned
Nov 30, 2007
Last updated
Dec 9, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kathleen D Keltz, O.D.NPI 1720040736
Title
Owner
Phone
(712) 551-1603

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X 01646 IA Primary

Addresses

Primary practice location

605 9TH St
Hawarden, IA 51023-2220

Mailing address

605 9TH St
Hawarden, IA 51023-2220
Phone (712) 551-1603

Other identifiers 3

IdentifierTypeStateIssuer
410005330OtherRAILROAD MEDICARE
9201220MedicaidSD
0147090MedicaidIA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1197158400000",
    "number": "1407038508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 9TH ST",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510232220",
            "telephone_number": "712-551-1603",
            "fax_number": "712-551-1490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 9TH ST",
            "city": "HAWARDEN",
            "state": "IA",
            "postal_code": "510232220",
            "telephone_number": "712-551-1603",
            "fax_number": "712-551-1490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KATHLEEN D KELTZ",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2007-12-09",
        "status": "A",
        "authorized_official_last_name": "KELTZ",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "712-551-1603",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "IA",
            "license": "01646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410005330",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9201220",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0147090",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hawarden, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.