Provider Demographics
NPI:1356477129
Name:KINNI EYECARE, INC.
Entity Type:Organization
Organization Name:KINNI EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KINNARI
Authorized Official - Middle Name:KALIND
Authorized Official - Last Name:BAKSHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-342-0440
Mailing Address - Street 1:7601 CASTOR AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-4026
Mailing Address - Country:US
Mailing Address - Phone:215-342-0440
Mailing Address - Fax:215-745-3950
Practice Address - Street 1:7601 CASTOR AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-4026
Practice Address - Country:US
Practice Address - Phone:215-342-0440
Practice Address - Fax:215-745-3950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026149-E152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0091969201Medicaid
PA003906Medicare ID - Type Unspecified
PAB29969Medicare UPIN