Provider Demographics
NPI:1053444125
Name:KITCHEL, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:KITCHEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1679 WOODMAN DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3336
Mailing Address - Country:US
Mailing Address - Phone:937-258-1515
Mailing Address - Fax:937-258-8790
Practice Address - Street 1:1679 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3336
Practice Address - Country:US
Practice Address - Phone:937-258-1515
Practice Address - Fax:937-258-8790
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician