Provider Demographics
NPI:1770282444
Name:KENNEDY EYECARE LLC
Entity type:Organization
Organization Name:KENNEDY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:KENNEDY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-429-1400
Mailing Address - Street 1:1400 E WADE WATTS AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5652
Mailing Address - Country:US
Mailing Address - Phone:918-429-1400
Mailing Address - Fax:
Practice Address - Street 1:1722 W LIBERTY RD
Practice Address - Street 2:
Practice Address - City:ATOKA
Practice Address - State:OK
Practice Address - Zip Code:74525-7452
Practice Address - Country:US
Practice Address - Phone:580-292-0144
Practice Address - Fax:580-292-0142
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KENNEDY EYECARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-01
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty