Provider Demographics
NPI:1922431154
Name:KINZLEY, KATHLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:
Last Name:KINZLEY
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 1:136 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736
Mailing Address - Country:US
Mailing Address - Phone:732-223-0202
Mailing Address - Fax:732-223-0490
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-3544
Practice Address - Country:US
Practice Address - Phone:732-223-0202
Practice Address - Fax:732-223-0490
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00649000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist