Provider Demographics
NPI:1679541536
Name:KENNEDY, WENDY A (OD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:A
Last Name:KENNEDY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:WENDY
Other - Middle Name:A
Other - Last Name:SCHULZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1067 4TH ST NE STE 350
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-5004
Mailing Address - Country:US
Mailing Address - Phone:507-775-2001
Mailing Address - Fax:507-775-0072
Practice Address - Street 1:1067 4TH ST NE STE 250
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-5004
Practice Address - Country:US
Practice Address - Phone:507-775-2001
Practice Address - Fax:507-775-0072
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN2995152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2300761OtherAMERICA'S PPO
MN2202645OtherMEDICA/UNITED HEALTH CARE
MN434L3KEOtherBC/BS
MN216982700Medicaid
MNMN2995OtherEYEMED
MN434L3KEOtherBC/BS
MN2202645OtherMEDICA/UNITED HEALTH CARE