Brian K Kindel OD PC
Organization Active NPI Optometrist · Fenton, MO
NPI 1013198381 · NPPES record last updated Nov 15, 2007
Key facts
- NPI
- 1013198381
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- 2001017654 (MO)
- Legal business name
- BRIAN K KINDEL OD PC
- Practice address
- 653 Gravois Bluffs Blvd
Fenton, MO 63026-7715 - Phone
- (636) 326-5389
- Fax
- (636) 326-9960
- NPI assigned
- Nov 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Brian Kenneth Kindel, O.D.
- Title
- President
- Phone
- (636) 326-5389
Practitioners 2
-
Brian Kindel, O.D.
-
Susanne S. Kindel, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080319000584 | MO | Part B Supplier - Clinic/Group Practice | 6305834243 |
Receives reassigned benefits from 2 practitioners Practice locations: Fenton, MO |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | 2001017654 | MO | Yes |
Addresses
Primary practice location
653 Gravois Bluffs Blvd
Fenton, MO 63026-7715
Mailing address
653 Gravois Bluffs Blvd
Fenton, MO 63026-7715
Phone (636) 326-5389
Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 15, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.