Organization
DR. JOHN D. MCKENNA OPTOMETRIST, LLC
Active
Other names
McKenna Family Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN D MCKENNA OD (OWNER/OPTOMETRIST)
(317) 899-1017
Entity
Organization
Contact information
Practice address
1511 N POST RD, INDIANAPOLIS, IN 46219-4247
(317) 899-1017
(317) 899-1660
Mailing address
1511 N POST RD, INDIANAPOLIS, IN 46219-4247
(317) 899-1017
(317) 899-1660
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003120B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104825900
—
IN
01
—
220830
MEDICARE ID - TYPE UNSPECIFIED
IN
01
—
P00701435
RAILROAD MEDICARE
IN
Enumeration date
10/19/2011
Last updated
10/19/2011
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