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General NPI Number Information
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NPI Number | 1235134982
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Entity Type | Individual
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Provider Name | KATHLEEN M RIVERA - KUNZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2005
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Last Update Date | 06/03/2009
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Provider Practice Location Address
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Address Line | 408 W 2ND ST
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City | CENTRALIA
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State | IL
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Zip | 62801-3402
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Country | US
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Telephone | 618-532-5531
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Fax | 618-532-6706
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Provider Business Mailing Address
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Address Line | 408 W 2ND ST
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City | CENTRALIA
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State | IL
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Zip | 62801-3402
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Country | US
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Telephone | 618-532-5531
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Fax | 618-532-6706
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008908
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License Number State | IL
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