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General NPI Number Information
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NPI Number | 1952494833
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Entity Type | Individual
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Provider Name | MICHAEL GARDNER KYNN OD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 01/24/2017
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Provider Practice Location Address
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Address Line | 9041 SOUTHSIDE BLVD SUITE 174
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5484
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Country | US
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Telephone | 904-519-5855
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Fax | 904-519-1165
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Provider Business Mailing Address
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Address Line | 9041 SOUTHSIDE BLVD SUITE 174
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5484
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Country | US
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Telephone | 904-519-5855
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Fax | 904-519-1165
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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 | OPC3539
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License Number State | FL
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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 | 1240395T
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0E7371P
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1148
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0601001915
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License Number State | VA
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Taxonomy #6
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2013
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License Number State | WA
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Taxonomy #7
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | R134TA518
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License Number State | AL
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