MEDICARE: LESTER R KITCHEN OPTOMETRIST INC

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

General Provider Information

NPI Number	:	1457465791
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LESTER R KITCHEN OPTOMETRIST INC

Provider Business Mailing Address
First Line	:	500 CANYON RDG
Second Line	:	SUITE L-350
City	:	AUSTIN
State	:	TX
Zip	:	78753-1632
Country	:	US
Telephone Number	:	512-837-3200
Fax Number	:	512-837-3206

Provider Business Practice Location Address
First Line	:	500 CANYON RDG
Second Line	:	SUITE L-350
City	:	AUSTIN
State	:	TX
Zip	:	78753-1632
Country	:	US
Telephone Number	:	512-837-3200
Fax Number	:	512-837-3206

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LESTER R KITCHEN
Credential	:	O.D.
Telephone Number	:	512-837-3200

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	11/20/2008

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