Provider Demographics
NPI:1720131030
Name:KIENER, JEFFREY J (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:KIENER
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 1:925 N STATE ST
Mailing Address - Street 2:STE J
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8023
Mailing Address - Country:US
Mailing Address - Phone:614-523-3949
Mailing Address - Fax:614-523-4361
Practice Address - Street 1:925 N STATE ST
Practice Address - Street 2:STE J
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8023
Practice Address - Country:US
Practice Address - Phone:614-523-3949
Practice Address - Fax:614-523-4361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4115 T-67152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT87922Medicare UPIN
KI-0653245Medicare ID - Type Unspecified