Organization
KENNEDY EYECARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRYSTIE LEIGH WESLEY (OFFICE MANAGER)
(918) 429-1400
Entity
Organization
Contact information
Practice address
1400 WADE WATTS AVE, MCALESTER, OK 74501
(918) 429-1400
(918) 429-1403
Mailing address
1400 WADE WATTS AVE, MCALESTER, OK 74501
(918) 429-1400
(918) 429-1403
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2160
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200454560A
—
OK
Enumeration date
07/17/2012
Last updated
12/30/2022
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