Provider Demographics
NPI:1336202449
Name:PILON, KENNETH D (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:D
Last Name:PILON
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 1:4580 STATE ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-3803
Mailing Address - Country:US
Mailing Address - Phone:989-799-0171
Mailing Address - Fax:989-799-6500
Practice Address - Street 1:4580 STATE ST
Practice Address - Street 2:GREEN ACRES PLAZA
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-3803
Practice Address - Country:US
Practice Address - Phone:989-799-0171
Practice Address - Fax:989-799-6500
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU34336Medicare UPIN
MIN26930127Medicare PIN