Individual
KENNETH KISAMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
14929 SHADY GROVE RD UNIT K, ROCKVILLE, MD 20850-7728
(301) 424-1050
(301) 424-3184
Mailing address
8614 WESTWOOD CENTER DR FL 9, VIENNA, VA 22182-2442
(703) 847-8899
(866) 795-4020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001710
VA
152W00000X
Optometrist
Primary
TA0917
MD
Other
Enumeration date
06/13/2006
Last updated
07/24/2024
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