Organization
KENNEDY VISION HEALTH CENTER, LLC
Active
Other names
Kenndy Vision Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY CHARLES TRAVERSE O.D. (DOCTOR)
(763) 545-8850
Entity
Organization
Contact information
Practice address
10600 OLD COUNTY ROAD 15, PLYMOUTH, MN 55441-6210
(763) 545-8850
(763) 544-1257
Mailing address
10600 OLD COUNTY ROAD 15, PLYMOUTH, MN 55441-6210
(763) 545-8850
(763) 544-1257
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01040808
PREFERRED ONE
MN
01
—
170285
UCARE
MN
01
—
2115782
MEDICA
MN
01
—
417R4KE
BCBS
MN
05
—
620020600
—
MN
01
—
99240
HEALTH PARTNERS
MN
01
—
DB1166
RAILROAD MEDICARE
MN
Enumeration date
10/03/2006
Last updated
08/20/2024
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