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General NPI Number Information
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NPI Number | 1124004338
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Entity Type | Individual
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Provider Name | CHARLES HENRY KINNEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 01/31/2018
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Provider Practice Location Address
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Address Line | 1950 OLD GALLOWS RD SUITE 520
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City | VIENNA
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State | VA
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Zip | 22182-3990
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Country | US
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Telephone | 703-847-8899
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Fax | 703-991-4051
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Provider Business Mailing Address
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Address Line | 14806 S ROSESCAPE CIR
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City | HERRIMAN
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State | UT
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Zip | 84096-6978
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Country | US
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Telephone | 336-613-8079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 110978-9934
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1074
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License Number State | NC
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