Provider Demographics
NPI:1942243514
Name:CHRISTOPHER, KENNETH EARL (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EARL
Last Name:CHRISTOPHER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:SUN CITY OPTICAL &
Other - Middle Name:
Other - Last Name:OPTOMETRIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:28081 BRADLEY RD
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92586-2207
Mailing Address - Country:US
Mailing Address - Phone:951-672-2010
Mailing Address - Fax:951-679-4050
Practice Address - Street 1:28081 BRADLEY RD
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:CA
Practice Address - Zip Code:92586-2207
Practice Address - Country:US
Practice Address - Phone:951-672-2010
Practice Address - Fax:951-679-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9224T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0948077OtherCIGNA
CA30448OtherCOLE MANAGED VISION
CASD0092240Medicaid
CA5640OtherHEALTHNET
CA03219OtherSPECTERA
CA902168OtherBLOCK VISION
CA113829OtherEYEMED/ECPA
CA263376OtherCLARITY VISION
CA2884OtherMEDICAL EYE SERVICES
CA50541OtherSAFEGUARD
CA5660130OtherAETNA
CA64408OtherSAFEGUARD HMO
CA6447OtherSAFEGUARD PPO
CA050504OtherNVA ADMINISTRATORS
CA050504OtherNVA ADMINISTRATORS
CA64408OtherSAFEGUARD HMO
CA2884OtherMEDICAL EYE SERVICES
CA30448OtherCOLE MANAGED VISION