Organization
LEASE EYE MD PC
Active
Other names
ST ANTHONY EYE CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
LOU ANN KIESSLING M.D. (OWNER)
(712) 792-8255
Entity
Organization
Contact information
Practice address
405 S CLARK ST, SUITE 220, CARROLL, IA 51401-3065
(712) 792-8255
(712) 792-8256
Mailing address
405 S CLARK ST, SUITE 220, CARROLL, IA 51401-3065
(712) 792-8255
(712) 792-8256
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
31091
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1139030
—
IA
01
—
45445
BCBS
IA
Enumeration date
03/17/2009
Last updated
10/11/2010
Update your record
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