Provider Demographics
NPI:1952391666
Name:UZICK, KENNETH I (OD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:I
Last Name:UZICK
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 1:8335 WESTCHESTER AVE
Mailing Address - Street 2:# 120
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5716
Mailing Address - Country:US
Mailing Address - Phone:214-361-1010
Mailing Address - Fax:214-823-9503
Practice Address - Street 1:8335 WESTCHESTER AVE
Practice Address - Street 2:# 120
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5716
Practice Address - Country:US
Practice Address - Phone:214-361-1010
Practice Address - Fax:214-823-9503
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-25
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5037TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU58157Medicare UPIN
TX8A0339Medicare PIN