Healthcare Provider Details

I. General information

NPI: 1104884618
Provider Name (Legal Business Name): NEIL A KENNEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 06/17/2021
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 JUNIPER ST
QUAKERTOWN PA
18951-1587
US

IV. Provider business mailing address

313 WILLOWBROOK RD
HORSHAM PA
19044-1314
US

V. Phone/Fax

Practice location:
  • Phone: 215-536-3450
  • Fax: 215-536-0102
Mailing address:
  • Phone: 610-265-1761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOE006587T
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: