Provider Demographics
NPI:1891941324
Name:JEW, KENNETH F (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:F
Last Name:JEW
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2901 TASMAN DR STE 208
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95054-1138
Mailing Address - Country:US
Mailing Address - Phone:800-454-2747
Mailing Address - Fax:408-486-0897
Practice Address - Street 1:2901 TASMAN DR STE 208
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1138
Practice Address - Country:US
Practice Address - Phone:800-454-2747
Practice Address - Fax:408-486-0897
Is Sole Proprietor?:No
Enumeration Date:2008-08-15
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13513 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist