Provider Demographics
NPI:1255540621
Name:HUNT, KENNETH C (OD)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:C
Last Name:HUNT
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 1:938 WILLISTON PARK PT
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2166
Mailing Address - Country:US
Mailing Address - Phone:407-444-4911
Mailing Address - Fax:407-444-4913
Practice Address - Street 1:938 WILLISTON PARK PT
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2166
Practice Address - Country:US
Practice Address - Phone:407-444-4911
Practice Address - Fax:407-444-4913
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist