MEDICARE: DR. BRIAN KINDEL 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
1	152W00000X	Optometrist	2001017654	MO

General Provider Information

NPI Number	:	1114943024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN KINDEL O.D.

Provider Business Mailing Address
First Line	:	653 GRAVOIS BLUFFS BLVD
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-7715
Country	:	US
Telephone Number	:	636-326-5389
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 GRAVOIS BLUFFS BLVD
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-7715
Country	:	US
Telephone Number	:	636-326-5389
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/15/2007

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