Healthcare Provider Details

I. General information

NPI: 1912071127
Provider Name (Legal Business Name): KENNEDY & PERKINS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 WHITNEY AVE
NEW HAVEN CT
06510-1217
US

IV. Provider business mailing address

80 WHITNEY AVE
NEW HAVEN CT
06510-1217
US

V. Phone/Fax

Practice location:
  • Phone: 203-624-3145
  • Fax: 203-867-8733
Mailing address:
  • Phone: 203-624-3145
  • Fax: 203-867-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number001178
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number001178
License Number StateCT

VIII. Authorized Official

Name: MR. RICHARD L. KENNEDY JR.
Title or Position: VICE-PRESIDENT
Credential: LICENSED OPTICIAN
Phone: 203-624-3145