Individual
DR. CHARLES HENRY KINNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-4051
Mailing address
14806 S ROSESCAPE CIR, HERRIMAN, UT 84096-6978
(336) 613-8079
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1074
NC
152W00000X
Optometrist
Primary
110978-9934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09490
BCBS PROVIDER #
NC
05
—
7909490
—
NC
Enumeration date
12/20/2005
Last updated
01/31/2018
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