Provider Demographics
NPI:1033818687
Name:PLUMM, KANDACE LYNN
Entity Type:Individual
Prefix:MRS
First Name:KANDACE
Middle Name:LYNN
Last Name:PLUMM
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 1:16280 DRESDEN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9024
Mailing Address - Country:US
Mailing Address - Phone:330-386-9354
Mailing Address - Fax:330-386-9631
Practice Address - Street 1:KANDACE PLUMM
Practice Address - Street 2:11425 STATE ROUTE 170
Practice Address - City:NEGLEY
Practice Address - State:OH
Practice Address - Zip Code:44441
Practice Address - Country:US
Practice Address - Phone:330-383-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.010069.S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician