Healthcare Provider Details

I. General information

NPI: 1245892397
Provider Name (Legal Business Name): DEVON KENNEDY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44815 FIG AVE
LANCASTER CA
93534-3144
US

IV. Provider business mailing address

PO BOX 420
TEMPLETON CA
93465-0420
US

V. Phone/Fax

Practice location:
  • Phone: 661-206-9753
  • Fax: 844-897-3788
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34233TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: