MEDICARE: DR. KEN N FACTOR OD

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	516	AZ

General Provider Information

NPI Number	:	1578514857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN N FACTOR OD

Provider Business Mailing Address
First Line	:	4324 E CACTUS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7636
Country	:	US
Telephone Number	:	602-996-9906
Fax Number	:	602-996-0943

Provider Business Practice Location Address
First Line	:	4324 E CACTUS RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85032-7636
Country	:	US
Telephone Number	:	602-996-9906
Fax Number	:	602-996-0943

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	03/07/2023

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