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General NPI Number Information
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NPI Number | 1679577548
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Entity Type | Individual
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Provider Name | DONALD E MCKIM OD
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Gender | Male
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 1610 W TOWNLINE ST STE 115
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City | CRESTON
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State | IA
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Zip | 50801-1064
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Country | US
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Telephone | 641-782-7619
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Fax | 641-782-6549
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Provider Business Mailing Address
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Address Line | PO BOX 427
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City | CRESTON
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State | IA
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Zip | 50801-0427
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Country | US
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Telephone | 641-782-7619
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Fax | 641-782-6549
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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 | 01847
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License Number State | IA
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