Individual
DR. KYLE JOHN STALDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
207 N CHESTNUT ST, JEFFERSON, IA 50129-1906
(515) 386-3513
Mailing address
207 N CHESTNUT ST, JEFFERSON, IA 50129-1906
(515) 386-3513
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02356
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0166322
—
IA
01
—
0547170001
DMERC
IA
01
—
0547170002
DMERC
IA
01
—
0547170004
DMERC
IA
01
—
0547170005
DMERC
IA
01
—
0547170006
DMERC
—
05
—
0724732
—
IA
05
—
1166322
—
IA
05
—
2166322
—
IA
05
—
4166322
—
IA
05
—
5166322
—
IA
Enumeration date
07/05/2006
Last updated
08/29/2018
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