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General NPI Number Information
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NPI Number | 1356477129
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Entity Type | Organization
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Legal Business Name | KINNI EYECARE, INC.
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7601 CASTOR AVE SUITE 204
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City | PHILADELPHIA
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State | PA
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Zip | 19152-4026
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Country | US
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Telephone | 215-342-0440
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Fax | 215-745-3950
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Provider Business Mailing Address
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Address Line | 7601 CASTOR AVE SUITE 204
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City | PHILADELPHIA
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State | PA
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Zip | 19152-4026
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Country | US
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Telephone | 215-342-0440
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Fax | 215-745-3950
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Authorized Official
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Title or Position | OWNER
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Name | DR. KINNARI KALIND BAKSHI
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Credential | M.D.
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Telephone | 215-342-0440
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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 | MD026149-E
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License Number State | PA
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