MEDICARE: KENNEDY VISION PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC4146	FL

General Provider Information

NPI Number	:	1104167345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENNEDY VISION PA

Provider Business Mailing Address
First Line	:	18503 PINES BLVD STE 205
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1405
Country	:	US
Telephone Number	:	954-430-8330
Fax Number	:	954-430-3638

Provider Business Practice Location Address
First Line	:	18503 PINES BLVD STE 205
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33029-1405
Country	:	US
Telephone Number	:	954-430-8330
Fax Number	:	954-430-3638

Authorized Official
Title or Position	:	OPTOMETRIST/OWNER
Name	:	CALEB JOSEPH KENNEDY
Credential	:	OD
Telephone Number	:	954-430-8330

Provider Enumeration Date	:	03/13/2013
Last Update Date	:	05/28/2025

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Directions to “KENNEDY VISION PA ” Practice Location

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