Provider Demographics
NPI:1114954344
Name:KENT, EDWARD TODD (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:TODD
Last Name:KENT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WEST 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7113
Mailing Address - Country:US
Mailing Address - Phone:212-243-4884
Mailing Address - Fax:
Practice Address - Street 1:223 WEST 14 TH STREET
Practice Address - Street 2:ECONOMY BEST VISION
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7113
Practice Address - Country:US
Practice Address - Phone:212-243-4884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004553-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00342970Medicaid