Healthcare Provider Details

I. General information

NPI: 1851520175
Provider Name (Legal Business Name): KEVIN MICHAEL BIERMANN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 04/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3071 PHOENIX CENTER DR
WASHINGTON MO
63090-5690
US

IV. Provider business mailing address

40 E NORTH ST
EUREKA MO
63025-1205
US

V. Phone/Fax

Practice location:
  • Phone: 636-777-2345
  • Fax: 636-777-2115
Mailing address:
  • Phone: 636-200-4393
  • Fax: 636-938-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2009017799
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: