Provider Demographics
NPI:1821026493
Name:KENSINGTON OPHTHALMOLOGY PLC
Entity Type:Organization
Organization Name:KENSINGTON OPHTHALMOLOGY PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:810-229-3363
Mailing Address - Street 1:10201 GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9591
Mailing Address - Country:US
Mailing Address - Phone:810-229-3363
Mailing Address - Fax:810-229-5532
Practice Address - Street 1:10201 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9591
Practice Address - Country:US
Practice Address - Phone:810-229-3363
Practice Address - Fax:810-229-5532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301055985207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6441590001Medicare NSC
MIF79556Medicare UPIN
MI0N34390Medicare ID - Type Unspecified