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Contact Information

KENNY R BLACKSTON, OD
102 W COVINGTON AVE
OPP, AL36467-2033
 Phone: 334-774-9396
 Fax: 334-774-1459
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for KENNY R BLACKSTON · (Male)

NPI # 1740286301
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 06/28/2005
Last updated 01/17/2008 - About 18 years ago
Sole proprietor 1 No
Identifiers
  • AL License # S950-TA-529
  • AL Other 22-10508 UNITED HEALTH CARE PROV #
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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