Organization
KENNETH H. BALLENTINE OD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH H BALLENTINE OD (DOCTOR)
(408) 255-0576
Entity
Organization
Contact information
Practice address
5275 PROSPECT RD, SAN JOSE, CA 95129-5031
(408) 255-0576
Mailing address
5275 PROSPECT RD, SAN JOSE, CA 95129-5031
(408) 255-0576
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
6863T
CA
332H00000X
Eyewear Supplier
Primary
6863T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0068630
—
CA
Enumeration date
02/13/2008
Last updated
09/06/2012
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