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NPI Code Detail

MEDICARE: DR. MORGAN KICKLITER

MEDICARE: DR. MORGAN KICKLITER
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
1152W00000XOptometrist5513FL

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 : 1487146635
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MORGAN KICKLITER
Provider Business Mailing Address
First Line : 161 HAMPTON POINT DR STE 3
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32092-3058
Country : US
Telephone Number : 904-287-9137
Fax Number : 904-287-9057
Provider Business Practice Location Address
First Line : 161 HAMPTON POINT DR STE 3
Second Line :
City : SAINT AUGUSTINE
State : FL
Zip : 32092-3058
Country : US
Telephone Number : 904-287-9137
Fax Number : 904-287-9057
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2018
Last Update Date : 05/12/2021

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Directions to “ DR. MORGAN KICKLITER ” Practice Location

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