Provider Demographics
NPI:1770574683
Name:JOANNE KUNDL OD PA II
Entity type:Organization
Organization Name:JOANNE KUNDL OD PA II
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNDL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-279-2212
Mailing Address - Street 1:10521 N KENDALL DR
Mailing Address - Street 2:STE E103
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-1554
Mailing Address - Country:US
Mailing Address - Phone:305-279-2212
Mailing Address - Fax:305-279-3746
Practice Address - Street 1:10521 N KENDALL DR
Practice Address - Street 2:SUITE E 103
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1554
Practice Address - Country:US
Practice Address - Phone:305-279-2212
Practice Address - Fax:305-279-3746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA00001665152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078231900Medicaid
FL19664AOtherBLUE CROSS BLUE SHIELD
FL277057OtherAVMED
FL620744800Medicaid
FLK3793Medicare PIN
FL277057OtherAVMED
FL4839580001Medicare NSC