Provider Demographics
NPI:1609131598
Name:NULL, KENDRA RACHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:RACHELLE
Last Name:NULL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KENDRA
Other - Middle Name:RACHELLE
Other - Last Name:DALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:594 CALLA LILLY WAY
Mailing Address - Street 2:
Mailing Address - City:TIFFIN
Mailing Address - State:IA
Mailing Address - Zip Code:52340-9236
Mailing Address - Country:US
Mailing Address - Phone:901-483-5633
Mailing Address - Fax:
Practice Address - Street 1:4801 E LINWOOD BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-2226
Practice Address - Country:US
Practice Address - Phone:816-861-4700
Practice Address - Fax:816-922-3382
Is Sole Proprietor?:No
Enumeration Date:2012-07-07
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089984152W00000X
TN3063152W00000X
MO2015035194152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist