Provider Demographics
NPI:1649408600
Name:REDDELL, ASHLEY SCHUELKE (OD)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:SCHUELKE
Last Name:REDDELL
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 1:2301 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-4214
Mailing Address - Country:US
Mailing Address - Phone:913-682-2929
Mailing Address - Fax:
Practice Address - Street 1:2301 10TH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-4214
Practice Address - Country:US
Practice Address - Phone:913-682-2929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-29
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2887152W00000X
KS1849152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist