Provider Demographics
NPI:1649258500
Name:KADES, PHILLIP ARNOLD (OD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:ARNOLD
Last Name:KADES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:797 DIANDREA DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2980
Mailing Address - Country:US
Mailing Address - Phone:330-864-8767
Mailing Address - Fax:
Practice Address - Street 1:31 CONSERVATORY DR
Practice Address - Street 2:
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4281
Practice Address - Country:US
Practice Address - Phone:330-745-4404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169731Medicaid
OH0169731Medicaid