Provider Demographics
NPI:1861503823
Name:MCKENZIE, KATHY JO (OD)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:JO
Last Name:MCKENZIE
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 1:1000 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1112152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100765650AMedicaid
OK4994830001OtherDMEPOS, PALMETTO
OKT40563Medicare UPIN
OK100765650AMedicaid