Provider Demographics
NPI:1275634602
Name:PLANK, KENNETH EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWARD
Last Name:PLANK
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 1:9648 N MAY AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-2714
Mailing Address - Country:US
Mailing Address - Phone:405-749-2002
Mailing Address - Fax:405-748-5704
Practice Address - Street 1:9648 N MAY AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-2714
Practice Address - Country:US
Practice Address - Phone:405-749-2002
Practice Address - Fax:405-748-5704
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKU02954Medicare UPIN
OK$$$$$$$$$WMedicare PIN