Provider Demographics
NPI:1366175416
Name:KIEKHAFER, ETHIN STANLEE (OD)
Entity type:Individual
Prefix:DR
First Name:ETHIN
Middle Name:STANLEE
Last Name:KIEKHAFER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ASSOCIATED EYE CARE
Mailing Address - Street 2:2950 CURVE CREST BLVD
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082
Mailing Address - Country:US
Mailing Address - Phone:651-275-3000
Mailing Address - Fax:
Practice Address - Street 1:ASSOCIATED EYE CARE
Practice Address - Street 2:2950 CURVE CREST BLVD
Practice Address - City:STILLWATER
Practice Address - State:MN
Practice Address - Zip Code:55082
Practice Address - Country:US
Practice Address - Phone:651-275-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-06
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3795207WX0120X
WI3820207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases SpecialistGroup - Multi-Specialty