Provider Demographics
NPI:1477666303
Name:DR KENNETH L WEINER
Entity Type:Organization
Organization Name:DR KENNETH L WEINER
Other - Org Name:OPTOMETRY CENTER OF SANTA CLARITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTOMETRIST
Authorized Official - Phone:661-251-1400
Mailing Address - Street 1:19000 SOLEDAD CANYON RD
Mailing Address - Street 2:
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91351-3362
Mailing Address - Country:US
Mailing Address - Phone:661-251-1400
Mailing Address - Fax:661-251-5323
Practice Address - Street 1:19000 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91351-3362
Practice Address - Country:US
Practice Address - Phone:661-251-1400
Practice Address - Fax:661-251-5323
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4325152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherEYEMED
CA=========OtherMEDICAL