Provider Demographics
NPI:1811052186
Name:MCNEIL, KENNETH W
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:W
Last Name:MCNEIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3662 THE PARK
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3324
Mailing Address - Country:US
Mailing Address - Phone:607-753-7514
Mailing Address - Fax:607-753-7515
Practice Address - Street 1:3662 THE PARK
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3324
Practice Address - Country:US
Practice Address - Phone:607-753-7514
Practice Address - Fax:607-753-7515
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4079156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No332H00000XSuppliersEyewear Supplier