Provider Demographics
NPI:1235148560
Name:KENNETH I UZICK OD PC
Entity Type:Organization
Organization Name:KENNETH I UZICK OD PC
Other - Org Name:DR. KENNETH I. UZICK AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:I
Authorized Official - Last Name:UZICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:214-361-1010
Mailing Address - Street 1:8335 WESTCHESTER AVE
Mailing Address - Street 2:#120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5717
Mailing Address - Country:US
Mailing Address - Phone:214-361-1010
Mailing Address - Fax:214-823-9503
Practice Address - Street 1:8335 WESTCHESTER AVE
Practice Address - Street 2:# 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5717
Practice Address - Country:US
Practice Address - Phone:214-361-1010
Practice Address - Fax:214-823-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5037TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00285UMedicare PIN