Provider Demographics
NPI:1861694291
Name:DR. KENNETH A LEBOW
Entity type:Organization
Organization Name:DR. KENNETH A LEBOW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-630-4502
Mailing Address - Street 1:345 EDWIN DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-4522
Mailing Address - Country:US
Mailing Address - Phone:757-497-5555
Mailing Address - Fax:757-499-2636
Practice Address - Street 1:345 EDWIN DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-4522
Practice Address - Country:US
Practice Address - Phone:757-630-4502
Practice Address - Fax:757-499-2636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0601000666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty