Provider Demographics
NPI:1376657916
Name:KUNDL, JOANNE (OD)
Entity type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:KUNDL
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 1:28 N HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-7416
Mailing Address - Country:US
Mailing Address - Phone:305-247-2334
Mailing Address - Fax:305-247-7101
Practice Address - Street 1:28 N HOMESTEAD BLVD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-7416
Practice Address - Country:US
Practice Address - Phone:305-247-2334
Practice Address - Fax:305-247-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078231900Medicaid
FLT84152Medicare UPIN
FL078231900Medicaid