Provider Demographics
NPI:1669635835
Name:DENNIS, KERI LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:KERI
Middle Name:LYNN
Last Name:DENNIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048
Mailing Address - Country:US
Mailing Address - Phone:913-250-0885
Mailing Address - Fax:913-250-0824
Practice Address - Street 1:5000 10TH AVE
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048
Practice Address - Country:US
Practice Address - Phone:913-250-0885
Practice Address - Fax:913-250-0824
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1806152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA1531Medicare PIN