Provider Demographics
NPI:1578508560
Name:KENNEY, DEBRA LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:LYNN
Last Name:KENNEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 JAINE LANE
Mailing Address - Street 2:
Mailing Address - City:CHESTER SPRINGS
Mailing Address - State:PA
Mailing Address - Zip Code:19425
Mailing Address - Country:US
Mailing Address - Phone:610-469-0660
Mailing Address - Fax:610-469-0660
Practice Address - Street 1:31 LEOPARD RD
Practice Address - Street 2:PEARLE VISION CENTER
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:484-595-0345
Practice Address - Fax:484-595-0163
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE6900P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011379780003Medicaid