Healthcare Provider Details

I. General information

NPI: 1952391666
Provider Name (Legal Business Name): KENNETH I UZICK O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 02/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8335 WESTCHESTER AVE # 120
DALLAS TX
75225-5716
US

IV. Provider business mailing address

8335 WESTCHESTER AVE # 120
DALLAS TX
75225-5716
US

V. Phone/Fax

Practice location:
  • Phone: 214-361-1010
  • Fax: 214-823-9503
Mailing address:
  • Phone: 214-361-1010
  • Fax: 214-823-9503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5037TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: