MEDICARE: DR. ANDREW JOSEPH KENDER JR. 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	3129	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	310928411035	OTHER	OH	CARE SOURCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760596910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW JOSEPH KENDER JR. O.D.

Provider Business Mailing Address
First Line	:	977 TOWNSHIP ROAD 2946
Second Line	:
City	:	PERRYSVILLE
State	:	OH
Zip	:	44864
Country	:	US
Telephone Number	:	937-620-9964
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 TROY ST
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45404-1852
Country	:	US
Telephone Number	:	937-620-9964
Fax Number	:

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

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	01/18/2008

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Directions to “ DR. ANDREW JOSEPH KENDER JR. O.D.” Practice Location

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