Individual
DR. KENNEDY HALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1919 E THOMAS RD, PHOENIX, AZ 85016-7710
(602) 933-3937
Mailing address
2108 E THOMAS RD STE 130, PHOENIX, AZ 85016-0008
(602) 933-3124
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OTP-002611
AZ
152WP0200X
Pediatric Optometrist
Primary
OTP-002611
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136936
—
AZ
Enumeration date
07/28/2022
Last updated
07/18/2023
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