Individual
MR. KENNETH M HAINSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
215 E HAWAII AVE STE 260, NAMPA, ID 83686-6011
(208) 593-7199
(208) 593-7195
Mailing address
215 E HAWAII AVE STE 260, NAMPA, ID 83686-6011
(208) 593-7199
(208) 593-7195
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
M8605
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010138765
BLUE SHIELD
ID
01
—
000010138766
BLUE SHIELD
ID
01
—
180044930
RAILROAD MEDICARE
ID
01
—
48801
BLUE CROSS
ID
05
—
806365500
—
ID
01
—
J6576
BLUE CROSS
ID
Enumeration date
10/21/2005
Last updated
06/12/2024
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