Provider Demographics
NPI:1275506180
Name:KENNEY, MARION MANCE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:MANCE
Last Name:KENNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:324 SHAFTESBURY LN
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8557
Mailing Address - Country:US
Mailing Address - Phone:843-871-0684
Mailing Address - Fax:843-797-7098
Practice Address - Street 1:7643 RIVERS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4073
Practice Address - Country:US
Practice Address - Phone:843-797-0731
Practice Address - Fax:843-797-7098
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC0760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD07605Medicaid
SC0681740001Medicare NSC
SCT25213Medicare UPIN
SCD07605Medicaid