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General NPI Number Information
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NPI Number | 1710845656
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Entity Type | Individual
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Provider Name | JACQUELYNN KADAS LDO
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Gender | Female
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 1840 TOWN PARK BLVD STE K
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City | GREEN
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State | OH
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Zip | 44685-7799
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Country | US
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Telephone | 631-356-7970
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Fax |
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Provider Business Mailing Address
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Address Line | 5702 BUFFHAM RD
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City | SEVILLE
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State | OH
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Zip | 44273-9604
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Country | US
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Telephone |
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Fax |
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | OP.017098-S
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License Number State | OH
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