Healthcare Provider Details

I. General information

NPI: 1679150569
Provider Name (Legal Business Name): JILLIAN IVY LITCHFIELD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 1ST AVE NE
CEDAR RAPIDS IA
52402-5431
US

IV. Provider business mailing address

1650 1ST AVE NE
CEDAR RAPIDS IA
52402-5431
US

V. Phone/Fax

Practice location:
  • Phone: 319-362-3937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberDO-07082
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: