MEDICARE: DR. RONALD KONRAD KITTL 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	OP0001938	FL

General Provider Information

NPI Number	:	1689733354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD KONRAD KITTL O.D.

Provider Business Mailing Address
First Line	:	1529 CHUKAR RDG
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-6455
Country	:	US
Telephone Number	:	727-734-4511
Fax Number	:

Provider Business Practice Location Address
First Line	:	27001 US HIGHWAY 19 N
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33761-3402
Country	:	US
Telephone Number	:	727-725-7432
Fax Number	:

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

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	07/08/2007

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