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General NPI Number Information
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NPI Number | 1104874643
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Entity Type | Individual
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Provider Name | KELLEY S BAUMHOVER O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/05/2006
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Last Update Date | 06/02/2020
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Provider Practice Location Address
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Address Line | 5901 WESTOWN PKWY STE 200
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City | WEST DES MOINES
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State | IA
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Zip | 50266-8207
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Country | US
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Telephone | 515-225-3546
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Fax | 515-224-5946
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Provider Business Mailing Address
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Address Line | 5901 WESTOWN PKWY STE 200
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City | WEST DES MOINES
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State | IA
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Zip | 50266-8207
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Country | US
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Telephone | 515-225-3546
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Fax | 515-224-5946
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2004019595
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 02485
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License Number State | IA
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