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Individual

DR. KEN E GANLY

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
402 BAYARD RD, SUITE 200, KENNETT SQUARE, PA 19348-1862
(484) 770-8132
(484) 770-8136
Mailing address
109 HILLSIDE LN, KENNETT SQUARE, PA 19348-2267
(484) 678-7276

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG-000362
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
460176
INDIVIDUAL AETNA ID
PA
01
PA7531
EYEMED INSURANCE PROVIDER
PA
Enumeration date
06/16/2005
Last updated
04/12/2024
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