Provider Demographics
NPI:1164563151
Name:KADLEC, JANAE (OD)
Entity Type:Individual
Prefix:DR
First Name:JANAE
Middle Name:
Last Name:KADLEC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 THE BOULEVARD SAINT LOUIS
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1118
Mailing Address - Country:US
Mailing Address - Phone:314-863-4200
Mailing Address - Fax:314-863-3570
Practice Address - Street 1:15 THE BOULEVARD SAINT LOUIS
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1118
Practice Address - Country:US
Practice Address - Phone:314-863-4200
Practice Address - Fax:314-863-3570
Is Sole Proprietor?:No
Enumeration Date:2007-02-11
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT03307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1595013Medicare PIN
MOU65195Medicare UPIN