MEDICARE: DR. TIMOTHY P. KENKEL & ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1487308003
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. TIMOTHY P. KENKEL & ASSOCIATES INC

Provider Business Mailing Address
First Line	:	11747 PRINCETON PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2521
Country	:	US
Telephone Number	:	513-671-5020
Fax Number	:	513-510-4733

Provider Business Practice Location Address
First Line	:	11747 PRINCETON PIKE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2521
Country	:	US
Telephone Number	:	513-607-4209
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. TIMOTHY P KENKEL
Credential	:	OD
Telephone Number	:	513-607-4209

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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