Healthcare Provider Details

I. General information

NPI: 1366734147
Provider Name (Legal Business Name): THOMAS J KANDL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS J KANDL MD

II. Dates (important events)

Enumeration Date: 05/11/2011
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4720 WATERS AVE
SAVANNAH GA
31404-6292
US

IV. Provider business mailing address

4720 WATERS AVE
SAVANNAH GA
31404-6292
US

V. Phone/Fax

Practice location:
  • Phone: 912-629-5968
  • Fax: 912-629-5821
Mailing address:
  • Phone: 912-629-5968
  • Fax: 912-629-5821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number080958
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number080958
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: