Provider Demographics
NPI:1346356086
Name:DEKINDER, JULIE LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:JULIE
Middle Name:LYNN
Last Name:DEKINDER
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:PATIENT CARE CENTER
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4400
Mailing Address - Country:US
Mailing Address - Phone:314-516-5116
Mailing Address - Fax:314-516-6708
Practice Address - Street 1:7840 NATURAL BRIDGE RD
Practice Address - Street 2:PATIENT CARE CENTER
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4617
Practice Address - Country:US
Practice Address - Phone:314-516-5161
Practice Address - Fax:314-516-5507
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2020-06-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2004018570152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1346356086Medicaid
MO1346356086Medicaid
V03439Medicare UPIN
MO257446782Medicare PIN
MO257447473Medicare PIN