Individual
DR. DENNIS KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D., FAAO
Contact information
Practice address
208 E ST, SANTA ROSA, CA 95404-4426
(707) 546-3836
Mailing address
208 E ST, SANTA ROSA, CA 95404-4426
(707) 546-3836
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
5412T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0950410001
CIGNA PIN
CA
05
—
SD0054120
—
CA
Enumeration date
11/06/2006
Last updated
07/09/2007
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