Provider Demographics
NPI:1063426740
Name:MCCANDLESS, KENNETH C (OD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:MCCANDLESS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 E FLAMINGO RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5190
Mailing Address - Country:US
Mailing Address - Phone:702-733-2020
Mailing Address - Fax:702-794-2797
Practice Address - Street 1:2110 E FLAMINGO RD
Practice Address - Street 2:SUITE 210
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5190
Practice Address - Country:US
Practice Address - Phone:702-733-2020
Practice Address - Fax:702-794-2797
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist