Provider Demographics
NPI:1013947068
Name:WESTCOTT, KENNETH ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:ROBERT
Last Name:WESTCOTT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 INNOVATION DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3869
Mailing Address - Country:US
Mailing Address - Phone:757-410-3005
Mailing Address - Fax:757-410-3335
Practice Address - Street 1:601 INNOVATION DR STE B
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3869
Practice Address - Country:US
Practice Address - Phone:757-410-3005
Practice Address - Fax:757-410-3335
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000528152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT90770Medicare UPIN
VAC09650Medicare ID - Type UnspecifiedGROUP NUMBER