Provider Demographics
NPI:1023794195
Name:NEUKAM, KENNEDY (OD)
Entity type:Individual
Prefix:DR
First Name:KENNEDY
Middle Name:
Last Name:NEUKAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9750 N THALES ROAD
Mailing Address - Street 2:
Mailing Address - City:DUBOIS
Mailing Address - State:IN
Mailing Address - Zip Code:47527
Mailing Address - Country:US
Mailing Address - Phone:812-631-5570
Mailing Address - Fax:
Practice Address - Street 1:1372 S RANGELINE RD
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2932
Practice Address - Country:US
Practice Address - Phone:317-420-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004415A152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics