Individual
DR. TODD ALAN KENMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
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
152WC0802X
Corneal and Contact Management Optometrist
2366
OK
152WL0500X
Low Vision Rehabilitation Optometrist
2366
OK
152WP0200X
Pediatric Optometrist
2366
OK
152WS0006X
Sports Vision Optometrist
2366
OK
152WV0400X
Vision Therapy Optometrist
2366
OK
152WX0102X
Occupational Vision Optometrist
2366
OK
332B00000X
Durable Medical Equipment & Medical Supplies
2366
OK
332H00000X
Eyewear Supplier
2366
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
010814058
TAX ID
OK
05
—
200019180B
—
OK
Enumeration date
07/28/2006
Last updated
02/07/2008
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