MEDICARE: KIRKWOOD EYE ASSOCIATES LLC

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	2011018480	MO

General Provider Information

NPI Number	:	1407252240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRKWOOD EYE ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	200 S KIRKWOOD RD STE 130
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-4335
Country	:	US
Telephone Number	:	314-394-3045
Fax Number	:	314-394-3049

Provider Business Practice Location Address
First Line	:	200 S KIRKWOOD RD STE 130
Second Line	:
City	:	KIRKWOOD
State	:	MO
Zip	:	63122-4335
Country	:	US
Telephone Number	:	314-394-3045
Fax Number	:	314-394-3049

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. ANDREW JOSEPH BIONDO
Credential	:	O.D.
Telephone Number	:	314-605-7966

Provider Enumeration Date	:	11/05/2014
Last Update Date	:	06/07/2024

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