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General NPI Number Information
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NPI Number | 1164573010
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Entity Type | Individual
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Provider Name | TIMOTHY PATRICK KENKEL O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 07/17/2019
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Provider Practice Location Address
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Address Line | 11700 PRINCETON PIKE SUITE F11
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City | CINCINNATI
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State | OH
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Zip | 45246-2535
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Country | US
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Telephone | 513-671-5020
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Fax |
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Provider Business Mailing Address
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Address Line | 11700 PRINCETON PIKE UNIT F11
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City | CINCINNATI
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State | OH
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Zip | 45246-2598
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Country | US
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Telephone | 513-671-1195
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Fax | 513-671-1197
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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 | 3809
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License Number State | OH
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