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NPI Code Detail

MEDICARE: MRS. BETH ANN KUNKEL O.D.

MEDICARE: MRS. BETH ANN KUNKEL O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist642SD

General Provider Information

NPI Number : 1053511188
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. BETH ANN KUNKEL O.D.
Provider Business Mailing Address
First Line : 1225 4TH ST NE
Second Line :
City : WATERTOWN
State : SD
Zip : 57201-1204
Country : US
Telephone Number : 605-882-4174
Fax Number :
Provider Business Practice Location Address
First Line : 1225 4TH ST NE
Second Line :
City : WATERTOWN
State : SD
Zip : 57201-1204
Country : US
Telephone Number : 605-882-4174
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2007
Last Update Date : 07/18/2007

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