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General NPI Number Information
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NPI Number | 1821047853
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Entity Type | Individual
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Provider Name | CHARLES RUDOLPH III O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8600 WARD PKWY #710
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City | KANSAS CITY
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State | MO
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Zip | 64114-2614
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Country | US
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Telephone | 816-523-8886
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Fax | 816-523-1810
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Provider Business Mailing Address
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Address Line | 11103 WEST AVE
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1370
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Country | US
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Telephone | 210-524-6663
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Fax | 210-524-6587
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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 | 2005020473
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License Number State | MO
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