Basic Information
| Provider Information | |||||||||
| NPI: | 1821144916 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIEFIUK | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5016 WAVEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | COMMERCE TOWNSHIP | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483821362 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2482494793 | ||||||||
| FaxNumber: | 7348533798 | ||||||||
| Practice Location | |||||||||
| Address1: | 22320 GODDARD RD | ||||||||
| Address2: | SVS | ||||||||
| City: | TAYLOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 48180 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7342873311 | ||||||||
| FaxNumber: | 7347593092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2007 | ||||||||
| LastUpdateDate: | 04/30/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901003019 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.