Provider Demographics
NPI:1578861647
Name:KENNEDY & PERKINS. INC.
Entity Type:Organization
Organization Name:KENNEDY & PERKINS. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:JR
Authorized Official - Credentials:LDO
Authorized Official - Phone:203-624-3145
Mailing Address - Street 1:80 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1217
Mailing Address - Country:US
Mailing Address - Phone:203-624-3145
Mailing Address - Fax:203-867-8733
Practice Address - Street 1:105 ELM ST
Practice Address - Street 2:UNIT 15
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4132
Practice Address - Country:US
Practice Address - Phone:860-388-4394
Practice Address - Fax:860-395-0200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001495332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004036372Medicaid
CT000637OtherOPTICIAN
CTR75881Medicare UPIN