Provider Demographics
NPI:1336100742
Name:BEST, KENNETH WHITTEN (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:WHITTEN
Last Name:BEST
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 1:8316 MEDICAL PLAZA DR SUITE E
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262
Mailing Address - Country:US
Mailing Address - Phone:704-547-1551
Mailing Address - Fax:
Practice Address - Street 1:8316 MEDICAL PLAZA DR SUITE E
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262
Practice Address - Country:US
Practice Address - Phone:704-547-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1079152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09068OtherBCBS
NC8909068Medicaid
NC1847127OtherUNITED HEALTHCARE
NC246397CMedicare PIN
NC09068OtherBCBS
NC1847127OtherUNITED HEALTHCARE
NC246397EMedicare PIN
NC8909068Medicaid
NC0485250003Medicare NSC