1982680237 NPI number — DR. CHAD R KLUVER OD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982680237 NPI number — DR. CHAD R KLUVER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLUVER
Provider First Name:
CHAD
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982680237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
777 TANGLEFOOT LN
Provider Second Line Business Mailing Address:
EYE SURGEONS ASSOCIATES PC
Provider Business Mailing Address City Name:
BETTENDORF
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52722-1650
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
563-323-2020
Provider Business Mailing Address Fax Number:
563-328-5694

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
777 TANGLEFOOT LN
Provider Second Line Business Practice Location Address:
EYE SURGEONS ASSOCIATES PC
Provider Business Practice Location Address City Name:
BETTENDORF
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52722-1650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
563-323-2020
Provider Business Practice Location Address Fax Number:
563-328-5694
Provider Enumeration Date:
12/19/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  02304 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 046009707 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0443077 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0740183 . This is a "IA GROUP MEDICAID" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 977130 . This is a "IL GROUP MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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