Organization
KENMORE EYECARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TODD ALAN KENMORE O.D. (PRESIDENT)
(405) 799-3030
Entity
Organization
Contact information
Practice address
513 N TELEPHONE RD, MOORE, OK 73160-4938
(405) 799-3030
(405) 799-3737
Mailing address
513 N TELEPHONE RD, MOORE, OK 73160-4938
(405) 799-3030
(405) 799-3737
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2366
OK
332B00000X
Durable Medical Equipment & Medical Supplies
2366
OK
332H00000X
Eyewear Supplier
2366
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200019180B
—
OK
Enumeration date
12/17/2007
Last updated
02/07/2008
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