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General NPI Number Information
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NPI Number | 1750387452
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Entity Type | Individual
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Provider Name | ALAN S KWIATEK O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 2035 ZUMBEHL RD
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City | SAINT CHARLES
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State | MO
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Zip | 63303-2723
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Country | US
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Telephone | 636-946-1176
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Fax | 636-946-1533
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Provider Business Mailing Address
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Address Line | 2035 ZUMBEHL RD
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City | SAINT CHARLES
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State | MO
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Zip | 63303-2723
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Country | US
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Telephone | 636-946-1176
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Fax | 636-946-1533
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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 | T02486
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License Number State | MO
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