Provider Demographics
NPI:1831191352
Name:BRINSKO, KENNETH (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:
Last Name:BRINSKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BLDG H100, SANTA MARGARITA ROAD
Mailing Address - Street 2:ATTENTION: CODE CS-PA
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:760-725-6641
Mailing Address - Fax:760-725-0083
Practice Address - Street 1:BLDG H100, SANTA MARGARITA ROAD
Practice Address - Street 2:ATTENTION: CODE CS-PA
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-6641
Practice Address - Fax:760-725-0083
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0072031207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology