Paul R Kennedy
Optometrist
2117 E Grand River Ave
Lansing
, Michigan 48912-3231
Paul R Kennedy
Optometrist
2117 E Grand River Ave
Lansing
, Michigan 48912-3231
(636) 527-0766
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About
Features
Specialties
- Optometrist
Languages spoken
- English
Location
First Address
- Paul R Kennedy
- Po Box 208177
- Dallas, TX
- Zip : 75320-8177
- Fax : (636) 527-0766
- Phone : (636) 200-4393
Second Address
- Paul R Kennedy
- 2117 E Grand River Ave
- Lansing, MI
- Zip : 48912-3231
- Fax : (517) 485-2220
- Phone : (517) 485-2213
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 152W00000X | Optometrist | 4901003763 | MI |
National Provider Identifier
| NPI | 1013063114 |
|---|---|
| Provider Name | Paul R Kennedy |
| First Address | Dallas, TX 75320-8177 |
| Second Address | Lansing, MI 48912-3231 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 25/01/2007 |
| Last Update Date | 18/01/2021 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 944801636 | (05) | MI |
| U58302 | (02) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.