Provider Demographics
NPI:1023691649
Name:KENZLI, KAINOA M (OD)
Entity type:Individual
Prefix:
First Name:KAINOA
Middle Name:M
Last Name:KENZLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:KAINOA
Other - Middle Name:M
Other - Last Name:KUENZLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1500 NW AMBERCREST WAY APT 301
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7781
Mailing Address - Country:US
Mailing Address - Phone:360-773-8675
Mailing Address - Fax:
Practice Address - Street 1:10300 SILVERDALE WAY NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7990
Practice Address - Country:US
Practice Address - Phone:360-633-2933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-02
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61173897152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist