Provider Demographics
NPI:1114071552
Name:KATHY J. MCKENZIE, O.D., INC.
Entity Type:Organization
Organization Name:KATHY J. MCKENZIE, O.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:405-634-2471
Mailing Address - Street 1:1000 SW 44TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3630
Mailing Address - Country:US
Mailing Address - Phone:405-634-2471
Mailing Address - Fax:405-634-1374
Practice Address - Street 1:1000 SW 44TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3630
Practice Address - Country:US
Practice Address - Phone:405-634-2471
Practice Address - Fax:405-634-1374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK4994830001Medicare NSC
OK100522052Medicare PIN