Provider Demographics
NPI:1538175617
Name:KAIL, BRADEN E (OD)
Entity type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:E
Last Name:KAIL
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:PO BOX 447
Mailing Address - Street 2:
Mailing Address - City:WAYNESBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44688-0447
Mailing Address - Country:US
Mailing Address - Phone:330-866-7732
Mailing Address - Fax:330-866-4069
Practice Address - Street 1:117 W LISBON ST
Practice Address - Street 2:
Practice Address - City:WAYNESBURG
Practice Address - State:OH
Practice Address - Zip Code:44688-9351
Practice Address - Country:US
Practice Address - Phone:330-866-7732
Practice Address - Fax:330-866-4069
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0302505Medicaid
OH0302505Medicaid
OH0872692Medicare PIN
1311010001Medicare NSC