MEDICARE: DR KENNETH L WEINER

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	4325	CA

General Provider Information

NPI Number	:	1477666303
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR KENNETH L WEINER

Provider Business Mailing Address
First Line	:	19000 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3362
Country	:	US
Telephone Number	:	661-251-1400
Fax Number	:	661-251-5323

Provider Business Practice Location Address
First Line	:	19000 SOLEDAD CANYON RD
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-3362
Country	:	US
Telephone Number	:	661-251-1400
Fax Number	:	661-251-5323

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENNETH LAWRENCE WEINER
Credential	:	OPTOMETRIST
Telephone Number	:	661-251-1400

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	08/22/2020

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