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General NPI Number Information
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NPI Number | 1841334018
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Entity Type | Individual
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Provider Name | BRYAN E. KALB O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6020 E 82ND ST JCPENNEY OPTICAL
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-4746
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Country | US
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Telephone | 317-842-2290
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Fax | 317-842-2290
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Provider Business Mailing Address
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Address Line | 10906 BELLE PLAINE BLVD
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City | FISHERS
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State | IN
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Zip | 46037-7113
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Country | US
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Telephone | 317-577-9247
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18001781B
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License Number State | IN
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