Healthcare Provider Details

I. General information

NPI: 1164408852
Provider Name (Legal Business Name): KENNETH VERN CAHILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/20/2020
Certification Date: 12/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

262 NEIL AVE STE 430
COLUMBUS OH
43215-7312
US

IV. Provider business mailing address

262 NEIL AVE STE 430
COLUMBUS OH
43215-7312
US

V. Phone/Fax

Practice location:
  • Phone: 614-221-7464
  • Fax: 614-221-8117
Mailing address:
  • Phone: 614-221-7464
  • Fax: 614-221-8117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number35.049318
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.049318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: