Individual
DR. KENNETH RICHARD STATSICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2803 CASHWELL DR, STE A, GOLDSBORO, NC 27534-4301
(919) 778-2015
(919) 778-4808
Mailing address
2803 CASHWELL DR, STE A, GOLDSBORO, NC 27534-4301
(919) 778-2015
(919) 778-4808
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2303
NC
152W00000X
Optometrist
OPC 4549
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12143984
CAQH
NC
01
—
5922830
MEDICAID PIN
NC
01
—
C374
MEDICARE PTAN
NC
Enumeration date
08/20/2010
Last updated
07/16/2025
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