Individual
DR. KENTON L LILYQUIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1813 W EHRINGHAUS ST, ELIZABETH CITY, NC 27909-4555
(252) 333-1155
(252) 451-5330
Mailing address
1813 W EHRINGHAUS ST, ELIZABETH CITY, NC 27909-4555
(252) 333-1155
(252) 451-5330
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0897
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09533
BCBSNC INDIVIDUAL NUMBER
NC
05
—
8909533
—
NC
Enumeration date
06/02/2006
Last updated
06/03/2010
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