Healthcare Provider Details

I. General information

NPI: 1013150085
Provider Name (Legal Business Name): WILLIAM C KADELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 GREEN VALLEY RD SUITE 202
FREEDOM CA
95019-3160
US

IV. Provider business mailing address

160 GREEN VALLEY RD SUITE 202
FREEDOM CA
95019-3160
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-2020
  • Fax: 831-728-4739
Mailing address:
  • Phone: 831-728-2020
  • Fax: 831-728-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberCA5159T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: