Provider Demographics
NPI:1316395874
Name:KIESS, MEREDITH RENEA (O D)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:RENEA
Last Name:KIESS
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:RENEA
Other - Last Name:DILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15933 CLAYTON RD STE 201
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:1725 BRICE RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2705
Practice Address - Country:US
Practice Address - Phone:614-861-7771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6471152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist