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NPI Code Detail

MEDICARE: K&J EYE CARE, PA

MEDICARE: K&J EYE CARE, 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
1152W00000XOptometristFL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1410029746OTHERFLRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417946120
Entity Type Code : Organization
Provider Name (Legal Business Name) : K&J EYE CARE, PA
Provider Business Mailing Address
First Line : 5632 26TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34207-3515
Country : US
Telephone Number : 941-751-4668
Fax Number : 941-751-4809
Provider Business Practice Location Address
First Line : 5632 26TH ST W
Second Line :
City : BRADENTON
State : FL
Zip : 34207-3515
Country : US
Telephone Number : 941-751-4668
Fax Number : 941-751-4809
Authorized Official
Title or Position : OWNER/OPTOMETRIST
Name : DR. KENNETH WAYNE LAWSON
Credential : O.D.
Telephone Number : 941-751-4668
Provider Enumeration Date : 10/14/2005
Last Update Date : 05/27/2010

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Directions to “K&J EYE CARE, PA ” Practice Location

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