Organization
KENS UNITED OPTICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH LAWRENCE GROLEAU DO (OWNER/ DISPENSING OPTICIAN)
(904) 276-4611
Entity
Organization
Contact information
Practice address
225 BLANDING BLVD, ORANGE PARK, FL 32073-3357
(904) 276-4611
Mailing address
225 BLANDING BLVD, ORANGE PARK, FL 32073-3357
(904) 276-4611
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
DO3062
FL
Other
Enumeration date
08/17/2016
Last updated
05/11/2017
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