1316395874 NPI number — DR. MEREDITH RENEA KIESS O. D.

Table of content: DR. MEREDITH RENEA KIESS O. D. (NPI 1316395874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316395874 NPI number — DR. MEREDITH RENEA KIESS O. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIESS
Provider First Name:
MEREDITH
Provider Middle Name:
RENEA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O. D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DILEY
Provider Other First Name:
MEREDITH
Provider Other Middle Name:
RENEA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316395874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15933 CLAYTON RD STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63011-2172
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-200-4393
Provider Business Mailing Address Fax Number:
636-527-0766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1725 BRICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REYNOLDSBURG
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43068-2705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-861-7771
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  6471 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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