Provider Demographics
NPI:1487628095
Name:KNEIP, KENT (OD)
Entity Type:Individual
Prefix:
First Name:KENT
Middle Name:
Last Name:KNEIP
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 1:1425 S HIGLEY RD
Mailing Address - Street 2:#103
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85296-4798
Mailing Address - Country:US
Mailing Address - Phone:480-840-6888
Mailing Address - Fax:480-840-3361
Practice Address - Street 1:1425 S HIGLEY RD
Practice Address - Street 2:#103
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4798
Practice Address - Country:US
Practice Address - Phone:480-840-6888
Practice Address - Fax:480-840-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZT108916Medicare PIN