Provider Demographics
NPI:1164573010
Name:KENKEL, TIMOTHY PATRICK (OD)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:PATRICK
Last Name:KENKEL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 PRINCETON PIKE
Mailing Address - Street 2:UNIT F11
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2598
Mailing Address - Country:US
Mailing Address - Phone:513-671-1195
Mailing Address - Fax:513-671-1197
Practice Address - Street 1:11700 PRINCETON PIKE SUITE F11
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2535
Practice Address - Country:US
Practice Address - Phone:513-671-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHKE0586152Medicare PIN
OHT80707Medicare UPIN