Provider Demographics
NPI:1437218484
Name:PENNIPEDE, VINCENT A (OD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:A
Last Name:PENNIPEDE
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 1:10120 W 119TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213
Mailing Address - Country:US
Mailing Address - Phone:913-339-9090
Mailing Address - Fax:913-339-6417
Practice Address - Street 1:10120 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213
Practice Address - Country:US
Practice Address - Phone:913-339-9090
Practice Address - Fax:913-339-6417
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1437218484OtherAETNA
KS20169013OtherBCBS KANSAS CITY
T76551Medicare UPIN
KSR19803BMedicare PIN
KS20169013OtherBCBS KANSAS CITY
KSR18803BMedicare PIN