MEDICARE: TRAVIS L KINDERKNECHT 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	1554	KS

General Provider Information

NPI Number	:	1285603381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS L KINDERKNECHT O.D.

Provider Business Mailing Address
First Line	:	PO BOX 307
Second Line	:
City	:	QUINTER
State	:	KS
Zip	:	67752-0307
Country	:	US
Telephone Number	:	785-754-2494
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 CASTLE ROCK RD
Second Line	:
City	:	QUINTER
State	:	KS
Zip	:	67752-9516
Country	:	US
Telephone Number	:	785-754-2494
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/30/2008

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