Kennedy, Paul R

Kennedy, Paul R is an individual health care provider with primary practice located at 2117 E Grand River Ave , Lansing MI 48912-3231. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Kennedy, Paul R can be contacted via phone (517) 485-2213.

Contact Information

Primary practice address
2117 E Grand River Ave Lansing MI 48912-3231
Phone: (517) 485-2213
Fax: (517) 485-2220
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X 4901003763 Michigan

Profile Details

NPI number 1013063114
LBN Legal business name Kennedy, Paul R
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 25th, 2007
Last updated Jan 18th, 2021 - about 3 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 1013063114 NPPES
Michigan MEDICAID 944801636

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