Healthcare Provider Details

I. General information

NPI: 1164090809
Provider Name (Legal Business Name): KEVIN J FENG OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2021
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N HARRISON ST
PRINCETON NJ
08540-3521
US

IV. Provider business mailing address

5717 225TH ST
OAKLAND GARDENS NY
11364-2042
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-9437
  • Fax:
Mailing address:
  • Phone: 718-913-0880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00712200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number27OA00712200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG003795
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: