Provider Demographics
NPI:1417946120
Name:K&J EYE CARE, PA
Entity Type:Organization
Organization Name:K&J EYE CARE, PA
Other - Org Name:BAYSHORE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:941-751-4668
Mailing Address - Street 1:5632 26TH ST W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-3515
Mailing Address - Country:US
Mailing Address - Phone:941-751-4668
Mailing Address - Fax:941-751-4809
Practice Address - Street 1:5632 26TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-3515
Practice Address - Country:US
Practice Address - Phone:941-751-4668
Practice Address - Fax:941-751-4809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL410029746OtherRAILROAD MEDICARE
FL620685900Medicaid
U47383Medicare UPIN
FL1247480001Medicare NSC
FLU46940Medicare UPIN
FLK1633Medicare PIN
FL410029746OtherRAILROAD MEDICARE
FL620685900Medicaid