Individual
DR. KENNETH H GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4040 W KENNEDY BLVD, TAMPA, FL 33609-2750
(813) 286-0433
(813) 286-0498
Mailing address
4040 W KENNEDY BLVD, TAMPA, FL 33609-2750
(813) 286-0433
(813) 286-0498
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC1473
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078017100
—
FL
Enumeration date
09/19/2005
Last updated
11/14/2008
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