Healthcare Provider Details

I. General information

NPI: 1871654103
Provider Name (Legal Business Name): RONALD FRANK KUYKENDALL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18120 BROOKHURST ST
FOUNTAIN VALLEY CA
92708-6727
US

IV. Provider business mailing address

9790 LA ESPERANZA AVE
FOUNTAIN VALLEY CA
92708-3560
US

V. Phone/Fax

Practice location:
  • Phone: 714-963-8349
  • Fax:
Mailing address:
  • Phone: 714-963-3977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5168 T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: