Provider Demographics
NPI:1548212673
Name:FEINAUER, KEN N (OD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:N
Last Name:FEINAUER
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 1:1180 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:MI
Mailing Address - Zip Code:48162-3190
Mailing Address - Country:US
Mailing Address - Phone:734-243-5300
Mailing Address - Fax:734-243-9956
Practice Address - Street 1:1180 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-3190
Practice Address - Country:US
Practice Address - Phone:734-243-5300
Practice Address - Fax:734-243-9956
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4453 T1109152W00000X
MI4901002690152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2612104Medicaid
MI180E810890OtherBCBS BCN
OH9310791OtherMEDICARE GROUP
MI4835269Medicaid
P00288208OtherMEDICARE RAILROAD
MI0N14190Medicare PIN
OH4171751Medicare PIN
OH9310794Medicare PIN
OH4171752Medicare PIN
MIN55410003Medicare PIN
MI4835269Medicaid
MIN14190010Medicare PIN
OH9310791OtherMEDICARE GROUP
MIU35449Medicare UPIN