Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OE006587T | PA |
NPI | 1104884618 |
---|---|
Provider Name | Neil A Kenney |
First Address | Horsham, PA 19044-1314 |
Second Address | Quakertown, PA 18951-1587 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 17/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T72751 | (02) | PA |