Provider Demographics
NPI:1073739157
Name:KENNETH K. MORSE, P.C.
Entity Type:Organization
Organization Name:KENNETH K. MORSE, P.C.
Other - Org Name:KENNETH K. MORSE, O.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:KARL
Authorized Official - Last Name:MORSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-265-4324
Mailing Address - Street 1:911 CY AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-4160
Mailing Address - Country:US
Mailing Address - Phone:307-267-9703
Mailing Address - Fax:307-234-1203
Practice Address - Street 1:911 CY AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82601-4160
Practice Address - Country:US
Practice Address - Phone:307-265-4324
Practice Address - Fax:307-234-1203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY259T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY9740Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER