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General NPI Number Information
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NPI Number | 1124130380
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Entity Type | Individual
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Provider Name | KENNETH ROBERT EYE DDS
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 408 S MAIN STREET
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City | WOODSTOCK
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State | VA
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Zip | 22664
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Country | US
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Telephone | 540-459-4341
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Fax | 540-459-1931
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Provider Business Mailing Address
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Address Line | 10172 BONNY BRAE LANE
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City | BROADWAY
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State | VA
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Zip | 22815
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Country | US
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Telephone | 540-896-9008
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Fax | 540-896-9099
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401007023
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License Number State | VA
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