Provider Demographics
NPI:1316228331
Name:SARAH A KENNEDY OD PA
Entity Type:Organization
Organization Name:SARAH A KENNEDY OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-373-9599
Mailing Address - Street 1:4816 SW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4782
Mailing Address - Country:US
Mailing Address - Phone:407-373-9599
Mailing Address - Fax:
Practice Address - Street 1:8075 SW HIGHWAY 200
Practice Address - Street 2:SUITE 107
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34481-7823
Practice Address - Country:US
Practice Address - Phone:352-369-3937
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-03
Last Update Date:2011-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty