Provider Demographics
NPI:1013150085
Name:KADELL, WILLIAM C (OD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:KADELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:160 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREEDOM
Mailing Address - State:CA
Mailing Address - Zip Code:95019-3160
Mailing Address - Country:US
Mailing Address - Phone:831-728-2020
Mailing Address - Fax:831-728-4739
Practice Address - Street 1:160 GREEN VALLEY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3160
Practice Address - Country:US
Practice Address - Phone:831-728-2020
Practice Address - Fax:831-728-4739
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA5159T152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy