Green, Kenneth H

Green, Kenneth H is an individual health care provider with primary practice located at 4040 W Kennedy Blvd , Tampa FL 33609-2750. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Green, Kenneth H can be contacted via phone (813) 286-0433.

Contact Information

Primary practice address
4040 W Kennedy Blvd Tampa FL 33609-2750
Phone: (813) 286-0433
Fax: (813) 286-0498
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OPC1473 Florida

Profile Details

NPI number 1659366375
LBN Legal business name Green, Kenneth H
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 19th, 2005
Last updated Nov 14th, 2008 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1659366375 NPPES
Florida MEDICAID 078017100

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