Provider Demographics
NPI:1952502734
Name:PRESTON, KENNETH ROBERT (OPTITIAN)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:ROBERT
Last Name:PRESTON
Suffix:
Gender:M
Credentials:OPTITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1516 U STREET NW #LL
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-8004
Mailing Address - Country:US
Mailing Address - Phone:202-299-9109
Mailing Address - Fax:202-299-9109
Practice Address - Street 1:1516 U STREET NW
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-8004
Practice Address - Country:US
Practice Address - Phone:202-299-9109
Practice Address - Fax:202-299-9109
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCOP1027OtherEYEMED VISION GROUP
DC920090OtherBLOCK VISION