Provider Demographics
NPI:1053354571
Name:CECIL, JAMES KENDALL (OD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENDALL
Last Name:CECIL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:J. KENDALL
Other - Middle Name:
Other - Last Name:CECIL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3469 N MAYO TRL
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3265
Mailing Address - Country:US
Mailing Address - Phone:606-432-5800
Mailing Address - Fax:606-437-2307
Practice Address - Street 1:3469 N MAYO TRL
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3265
Practice Address - Country:US
Practice Address - Phone:606-432-5800
Practice Address - Fax:606-437-2307
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1043DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY410027123OtherRAILROAD MEDICARE
KY77010437Medicaid
KY000000176212OtherANTHEM BC/BS PROVIDER NUM
KY1043DTOtherLICENSE NUMBER
KY1043DTOtherLICENSE NUMBER
KY000000176212OtherANTHEM BC/BS PROVIDER NUM
KY1043DTOtherLICENSE NUMBER
KY9223101Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
KY0340400001Medicare NSC