Provider Demographics
NPI:1578514857
Name:FACTOR, KEN N (OD)
Entity Type:Individual
Prefix:DR
First Name:KEN
Middle Name:N
Last Name:FACTOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4324 E CACTUS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-7636
Mailing Address - Country:US
Mailing Address - Phone:602-996-9906
Mailing Address - Fax:602-996-0943
Practice Address - Street 1:4324 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7636
Practice Address - Country:US
Practice Address - Phone:602-996-9906
Practice Address - Fax:602-996-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMF0691065OtherDEA
AZT41594Medicare UPIN