Provider Demographics
NPI:1982813978
Name:MCKENNA, JUDITH ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNE
Last Name:MCKENNA
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 1:102 COMMONWEALTH CT
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511-4400
Mailing Address - Country:US
Mailing Address - Phone:919-469-8868
Mailing Address - Fax:
Practice Address - Street 1:102 COMMONWEALTH CT
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-4400
Practice Address - Country:US
Practice Address - Phone:919-469-8868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1169152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist