Provider Demographics
NPI:1013198381
Name:BRIAN K KINDEL OD PC
Entity Type:Organization
Organization Name:BRIAN K KINDEL OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:KINDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-326-5389
Mailing Address - Street 1:653 GRAVOIS BLUFFS BLVD
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7715
Mailing Address - Country:US
Mailing Address - Phone:636-326-5389
Mailing Address - Fax:636-326-9960
Practice Address - Street 1:653 GRAVOIS BLUFFS BLVD
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-7715
Practice Address - Country:US
Practice Address - Phone:636-326-5389
Practice Address - Fax:636-326-9960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001017654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOU97793Medicare UPIN