Provider Demographics
NPI:1841461902
Name:MARION M. KENNEY, O.D.
Entity type:Organization
Organization Name:MARION M. KENNEY, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:MANCE
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-797-0737
Mailing Address - Street 1:7643 RIVERS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-4073
Mailing Address - Country:US
Mailing Address - Phone:843-797-0737
Mailing Address - Fax:843-797-7098
Practice Address - Street 1:7643 RIVERS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4073
Practice Address - Country:US
Practice Address - Phone:843-797-0737
Practice Address - Fax:843-797-7098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC0760152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9952Medicaid
SCDA9952Medicaid
SCT252130281Medicare PIN
SCDA9952Medicaid
SC0681740001Medicare NSC