Healthcare Provider Details

I. General information

NPI: 1467134841
Provider Name (Legal Business Name): KENNETH WARD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33080 UTICA RD STE B
FRASER MI
48026-2038
US

IV. Provider business mailing address

33080 UTICA RD STE B
FRASER MI
48026-2038
US

V. Phone/Fax

Practice location:
  • Phone: 586-296-7250
  • Fax: 586-296-7256
Mailing address:
  • Phone: 586-296-7250
  • Fax: 586-296-7256

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901005684
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: