Provider Demographics
NPI:1659598316
Name:KRONICK, KENNETH A (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:A
Last Name:KRONICK
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 1:12328 WASHINGTON PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-4923
Mailing Address - Country:US
Mailing Address - Phone:310-397-0857
Mailing Address - Fax:310-313-2020
Practice Address - Street 1:12328 WASHINGTON PL
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-4923
Practice Address - Country:US
Practice Address - Phone:310-397-0857
Practice Address - Fax:310-313-2020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5293T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist