MEDICARE: JUSTIN MICHAEL KENDALL OD

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	2020015698	MO

General Provider Information

NPI Number	:	1932727120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN MICHAEL KENDALL OD

Provider Business Mailing Address
First Line	:	PO BOX 843966
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64184-3966
Country	:	US
Telephone Number	:	573-884-3300
Fax Number	:	573-884-0943

Provider Business Practice Location Address
First Line	:	3215 WINGATE CT STE 103
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65201-7689
Country	:	US
Telephone Number	:	573-884-3937
Fax Number	:	573-884-4868

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

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	11/19/2025

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