Individual
KIRK C WHITTLESEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
12 TAFT ST S, HUMBOLDT, IA 50548-2037
(515) 332-2950
(515) 332-4451
Mailing address
P O BOX 648, 12 TAFT ST S, HUMBOLDT, IA 50548-2037
(515) 332-2950
(515) 332-4451
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1581
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0226282
—
IA
01
—
1581
ALL OTHER HEALTH CARE
—
01
—
2262820
BCBS
IA
01
—
410012199
RR MEDICARE
—
Enumeration date
09/01/2005
Last updated
11/15/2012
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