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General NPI Number Information
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NPI Number | 1376733949
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Entity Type | Organization
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Legal Business Name | KUNKEL-SNYDER OPTOMETRIC, P.C
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 12/05/2007
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Provider Practice Location Address
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Address Line | 1225 4TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-1204
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Country | US
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Telephone | 605-882-4175
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Fax | 605-882-2962
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Provider Business Mailing Address
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Address Line | 1225 4TH ST NE
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City | WATERTOWN
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State | SD
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Zip | 57201-1204
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Country | US
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Telephone | 605-882-4175
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Fax | 605-882-2962
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW C KUNKEL
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Credential | O.D
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Telephone | 605-882-4175
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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 | 643
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License Number State | SD
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