NPIMap

Organization Active NPI

Kennedy Eyecare LLC

  • Optometrist
  • Checotah, OK
National Provider Identifier
1033822135
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
KENNEDY EYECARE LLC
Practice address
205 W Okmulgee Ave
Checotah, OK 74426-2408
Phone
(918) 473-2308
NPI assigned
Jan 4, 2023
Last updated
Jan 4, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
KENNEDY EYECARE LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Craig KennedyNPI 1992768113
Title
O.D.
Phone
(918) 429-1400

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

205 W Okmulgee Ave
Checotah, OK 74426-2408

Mailing address

1400 E Wade Watts Ave
McAlester, OK 74501-5652
Phone (918) 429-1400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20121031000660 OK Part B Supplier - Clinic/Group Practice 1557511367 Receives reassigned benefits from 4 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Atoka, OK; Checotah, OK; McAlester, OK

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Kennedy Eyecare LLC3 organizations share this tax ID, including this one
Part of
Kennedy Eyecare LLC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1672790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1033822135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E WADE WATTS AVE",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "745015652",
            "telephone_number": "918-429-1400",
            "fax_number": "918-429-1403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 W OKMULGEE AVE",
            "city": "CHECOTAH",
            "state": "OK",
            "postal_code": "744262408",
            "telephone_number": "918-473-2308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNEDY EYECARE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENNEDY EYECARE LLC",
        "enumeration_date": "2023-01-04",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-03",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "CRAIG",
        "authorized_official_title_or_position": "O.D.",
        "authorized_official_telephone_number": "918-429-1400"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Checotah, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.