Individual
PIERCE E KENWORTHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
5865 W UTOPIA RD, GLENDALE, AZ 85308-5251
(623) 806-7200
(623) 806-7210
Mailing address
19389 N 59TH AVE, GLENDALE, AZ 85308-6500
(623) 537-6000
(623) 537-6014
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
8515T
TX
152W00000X
Optometrist
Primary
OPT-002162
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124091-04
—
TX
05
—
255238
—
AZ
Enumeration date
08/01/2014
Last updated
12/11/2019
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