Statsick, Kenneth Richard
Statsick, Kenneth Richard is an sole proprietor health care provider with primary practice located at 2803 Cashwell Dr Ste A, Goldsboro NC 27534-4301. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Statsick, Kenneth Richard can be contacted via phone (919) 778-2015.Contact Information
Primary practice address
2803 Cashwell Dr Ste A
Goldsboro NC 27534-4301
Phone: (919) 778-2015
Fax: (919) 778-4808
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OPC 4549 | Florida |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2303 | North Carolina |
Profile Details
| NPI number | 1407162043 |
|---|---|
| LBN Legal business name | Statsick, Kenneth Richard |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 20th, 2010 |
| Last updated | Oct 18th, 2022 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407162043 | NPPES |
| North Carolina | Other | C374 | MEDICARE PTAN |
| North Carolina | Other | 12143984 | MEDICARE PTAN |
| North Carolina | Other | 5922830 | MEDICARE PTAN |
| North Carolina | Other | 5922830 | MEDICARE PTAN |
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