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NPI Code Detail

MEDICARE: DR. JERRY KASSEL O.D.

MEDICARE: DR. JERRY KASSEL O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristT03445MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2410046214OTHERMORAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306842398
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JERRY KASSEL O.D.
Provider Business Mailing Address
First Line : 40 E NORTH ST
Second Line :
City : EUREKA
State : MO
Zip : 63025-1205
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-938-2650
Provider Business Practice Location Address
First Line : 3936 VOGEL RD
Second Line :
City : ARNOLD
State : MO
Zip : 63010-3790
Country : US
Telephone Number : 636-282-4982
Fax Number : 636-296-3376
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 11/18/2014

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