MEDICARE: DR. LESLIE KINDER OD

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	2131	SC
2	152W00000X	Optometrist	2019021310	MO

General Provider Information

NPI Number	:	1790345429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE KINDER OD

Provider Business Mailing Address
First Line	:	2311 MCKELVEY RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1531
Country	:	US
Telephone Number	:	314-434-9450
Fax Number	:	314-434-0151

Provider Business Practice Location Address
First Line	:	2311 MCKELVEY RD
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1531
Country	:	US
Telephone Number	:	314-434-9450
Fax Number	:	314-434-0151

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

Provider Enumeration Date	:	06/14/2019
Last Update Date	:	04/19/2022

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