Provider Demographics
NPI:1871129940
Name:KORDES, KALYN ROSE
Entity type:Individual
Prefix:
First Name:KALYN
Middle Name:ROSE
Last Name:KORDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3125
Mailing Address - Country:US
Mailing Address - Phone:812-482-6010
Mailing Address - Fax:
Practice Address - Street 1:501 CLAY ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3125
Practice Address - Country:US
Practice Address - Phone:812-482-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-20
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004223B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist