Provider Demographics
NPI:1407252240
Name:KIRKWOOD EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:KIRKWOOD EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BIONDO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-605-7966
Mailing Address - Street 1:200 S KIRKWOOD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4335
Mailing Address - Country:US
Mailing Address - Phone:314-394-3045
Mailing Address - Fax:314-394-3049
Practice Address - Street 1:200 S KIRKWOOD RD STE 100
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122-4335
Practice Address - Country:US
Practice Address - Phone:314-394-3045
Practice Address - Fax:314-394-3049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-05
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011018480152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty