Provider Demographics
NPI:1427037589
Name:PURK, KENNETH DAVID JR (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DAVID
Last Name:PURK
Suffix:JR
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 1:109 WINGATE DR
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8413
Mailing Address - Country:US
Mailing Address - Phone:252-635-9386
Mailing Address - Fax:
Practice Address - Street 1:NAVAL HOSPITAL
Practice Address - Street 2:MARINE CORPS AIR STATION CHERRY POINT
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28533
Practice Address - Country:UM
Practice Address - Phone:252
Practice Address - Fax:0266
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3436 / T1525152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist