Individual
DR. DAVID LAWRENCE KENNEDY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
LF1587000
MN
152WC0802X
Corneal and Contact Management Optometrist
LD1587000
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2202707
MEDICA
MN
01
—
417R6KE
BCBS
MN
05
—
963723100
—
MN
01
—
977521011194
PREFERRED ONE
MN
Enumeration date
09/26/2006
Last updated
12/10/2008
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