Provider Demographics
NPI:1780025411
Name:HEADINGTON, KENNETH (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:HEADINGTON
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 1:7400 E ORCHARD RD
Mailing Address - Street 2:SUITE 175-S
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2528
Mailing Address - Country:US
Mailing Address - Phone:303-850-9499
Mailing Address - Fax:303-850-7032
Practice Address - Street 1:7400 E ORCHARD RD
Practice Address - Street 2:SUITE 175-S
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2528
Practice Address - Country:US
Practice Address - Phone:303-850-9499
Practice Address - Fax:303-850-7032
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-10
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002967152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics