Individual
PAUL R KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2117 E GRAND RIVER AVE, LANSING, MI 48912-3231
(517) 485-2213
(517) 485-2220
Mailing address
PO BOX 208177, DALLAS, TX 75320-8177
(636) 200-4393
(636) 527-0766
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901003763
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
944801636
—
MI
Enumeration date
01/25/2007
Last updated
01/18/2021
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