Provider Demographics
NPI:1083826374
Name:KENNEDY OPHTHALMIC ASSOCIATES PLLC
Entity Type:Organization
Organization Name:KENNEDY OPHTHALMIC ASSOCIATES PLLC
Other - Org Name:KENNEDY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-377-3439
Mailing Address - Street 1:1675 PROVIDENCE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309
Mailing Address - Country:US
Mailing Address - Phone:518-377-2144
Mailing Address - Fax:518-377-0436
Practice Address - Street 1:1675 PROVIDENCE AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-377-2144
Practice Address - Fax:518-377-0436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0061131332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier