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General NPI Number Information
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NPI Number | 1801194964
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Entity Type | Organization
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Legal Business Name | KENNEDY & PERKINS, INC.
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Dates
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Enumeration Date | 03/14/2011
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Last Update Date | 03/14/2011
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Provider Practice Location Address
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Address Line | 1957 WHITNEY AVE
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City | NORTH HAVEN
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State | CT
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Zip | 06473-4432
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Country | US
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Telephone | 203-281-0290
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Fax | 203-248-6503
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Provider Business Mailing Address
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Address Line | 80 WHITNEY AVE
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City | NEW HAVEN
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State | CT
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Zip | 06510-1217
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Country | US
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Telephone | 203-624-3145
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Fax | 203-867-8733
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. RICHARD L KENNEDY JR.
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Credential | LDO
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Telephone | 203-624-3145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 001026
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License Number State | CT
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