Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | #299 | KY |
NPI | 1164551644 |
---|---|
Provider Name | Mr. Terry L. Kennedy |
First Address | Middletown, KY 40243-1420 |
Second Address | Middletown, KY 40243-1420 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/03/2007 |
Last Update Date | 11/02/2008 |