Provider Demographics
NPI:1013242106
Name:KINZER, EILENE EUGENIO (OD)
Entity Type:Individual
Prefix:DR
First Name:EILENE
Middle Name:EUGENIO
Last Name:KINZER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:EILENE
Other - Middle Name:JAO
Other - Last Name:EUGENIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:147 SYCAMORE ST
Mailing Address - Street 2:KENTUCKY COLLEGE OF OPTOMETRY
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-9118
Mailing Address - Country:US
Mailing Address - Phone:606-218-5514
Mailing Address - Fax:
Practice Address - Street 1:147 SYCAMORE ST
Practice Address - Street 2:KENTUCKY COLLEGE OF OPTOMETRY
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-9118
Practice Address - Country:US
Practice Address - Phone:606-218-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2021-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2006DT152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA201080570Medicaid
KY7100397540Medicaid
VAM400074960Medicare PIN