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General NPI Number Information
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NPI Number | 1487981197
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Entity Type | Organization
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Legal Business Name | KANDI S. MOLLER, OD, LLC
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Dates
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Enumeration Date | 11/17/2009
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 3031 KILLDEER AVE SE
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City | ALBANY
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State | OR
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Zip | 97322-5325
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Country | US
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Telephone | 541-926-2521
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Fax | 541-918-7065
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Provider Business Mailing Address
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Address Line | 1037 8TH AVE SW
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City | ALBANY
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State | OR
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Zip | 97321-2053
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Country | US
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Telephone | 541-926-2521
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Fax | 541-918-7065
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | KANDI SUE MOLLER
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Credential | OD
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Telephone | 541-926-2521
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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 | 2733 ATI
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License Number State | OR
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