Individual
CRAIG KENNEDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1400 E WADE WATTS AVE, MCALESTER, OK 74501-5652
(918) 429-1400
(918) 429-1403
Mailing address
1400 E WADE WATTS AVE, MCALESTER, OK 74501-5652
(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
01
—
0166707
UMWA
OK
05
—
100763340B
—
OK
01
—
1324230001
PALMETTO DME
OK
01
—
731310891006
UNICARE
OK
01
—
731310891028
TRICARE SOUTH
OK
01
—
74502A002
CHAMPUS (WPS)
OK
01
—
U56560
STERLING OPTION 1
OK
Enumeration date
04/10/2006
Last updated
12/30/2022
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