Provider Demographics
NPI:1154892263
Name:KENNEDY, CATHERINE A (OD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:ANN
Other - Last Name:KENNEDY RIGGS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:83 CAMBRIDGE ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-4181
Mailing Address - Country:US
Mailing Address - Phone:781-272-2187
Mailing Address - Fax:781-229-0869
Practice Address - Street 1:83 CAMBRIDGE ST STE 1D
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4181
Practice Address - Country:US
Practice Address - Phone:781-272-2187
Practice Address - Fax:781-229-0869
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2694152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy