MEDICARE: DR. BRADFORD B. KESLER 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
1	152W00000X	Optometrist	T03416	MO

General Provider Information

NPI Number	:	1548269954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADFORD B. KESLER O.D.

Provider Business Mailing Address
First Line	:	PO BOX 13
Second Line	:
City	:	CRYSTAL CITY
State	:	MO
Zip	:	63019-0013
Country	:	US
Telephone Number	:	618-610-1619
Fax Number	:	636-937-2742

Provider Business Practice Location Address
First Line	:	1400 US HIGHWAY 61
Second Line	:	SUITE 130
City	:	FESTUS
State	:	MO
Zip	:	63028-4100
Country	:	US
Telephone Number	:	636-937-8855
Fax Number	:	636-937-3751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/21/2016

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