Provider Demographics
NPI:1508081381
Name:KORNEISEL, KENT ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:ALAN
Last Name:KORNEISEL
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 1:9853 45TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2710
Mailing Address - Country:US
Mailing Address - Phone:206-420-1015
Mailing Address - Fax:206-420-1015
Practice Address - Street 1:DR JENNIFER ANDREWS & ASSOC
Practice Address - Street 2:THIRD AVE. & PINE ST
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98181-0001
Practice Address - Country:US
Practice Address - Phone:206-344-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-007678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist