Provider Demographics
NPI:1982612289
Name:MAHAFFEY, KENDRA LEA (OD)
Entity Type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:LEA
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3057 LOST NATION RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-7672
Mailing Address - Country:US
Mailing Address - Phone:440-942-0887
Mailing Address - Fax:440-942-9374
Practice Address - Street 1:7529 FREDLE DR
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9406
Practice Address - Country:US
Practice Address - Phone:440-853-8581
Practice Address - Fax:440-853-8582
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5130/T2029152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist