Dr. John D. McKenna, Optometrist, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

18003120B Issued in IN

Legal business name

DR. JOHN D. MCKENNA, OPTOMETRIST, LLC

Doing business as

McKenna Family Eye Care

Practice address

1511 N Post Rd
Indianapolis, IN 46219-4247

Phone

(317) 899-1017

Fax

(317) 899-1660

NPI assigned

Jun 24, 2014

Organization subpart

No

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

Authorized official

Name

Dr. John David McKenna II, O.D.

Title

Managing Member

Phone

(317) 899-1017

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• McKenna Family Eye Care Doing business as

Tax ID family

Dr John D McKenna Optometrist LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Dr. John D. McKenna Optometrist, LLC

  • Optometrist
  • Indianapolis, IN
  • NPI 1326323502
  NPD tax ID

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tiffany Massela, OD

  • Optometrist
  • Indianapolis, IN
  • NPI 1033143631
  NPD (past)

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1403568000000",
    "number": "1245645720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1511 N POST RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194247",
            "telephone_number": "317-899-1017",
            "fax_number": "317-899-1660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1511 N POST RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194247",
            "telephone_number": "317-899-1017",
            "fax_number": "317-899-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. JOHN D. MCKENNA, OPTOMETRIST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-24",
        "last_updated": "2014-06-24",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "317-899-1017",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003120B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104825900",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID- TYPE UNSPECIFIED",
            "identifier": "220830",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McKenna Family Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.