Basic Information
| Provider Information | |||||||||
| NPI: | 1942225446 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COHEN | ||||||||
| FirstName: | KENNETH | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 MASON FARM RD | ||||||||
| Address2: | 5151 BIOINFORMATICS BUILDING, CB# 7040 | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199665296 | ||||||||
| FaxNumber: | 9199661908 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 MASON FARM RD | ||||||||
| Address2: | KITTNER EYE CENTER | ||||||||
| City: | CHAPEL HILL | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275997720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199662061 | ||||||||
| FaxNumber: | 9199666482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 10/21/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 22903 | NC | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 8923525 | 05 | NC | MEDICAID |