Provider Demographics
NPI:1477764298
Name:KENNEDY, EDWARD H (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:H
Last Name:KENNEDY
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 1:7525 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125-2207
Mailing Address - Country:US
Mailing Address - Phone:901-751-0740
Mailing Address - Fax:901-757-3624
Practice Address - Street 1:7525 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38125-2207
Practice Address - Country:US
Practice Address - Phone:901-751-0740
Practice Address - Fax:901-757-3624
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD791152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist