Kedzymac Enterprises, LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

KEDZYMAC ENTERPRISES, LLC

Doing business as

Cleveland Vision Center

Practice address

107 S Broadway St
Cleveland, OK 74020-4614

Phone

(918) 385-2245

NPI assigned

Jun 6, 2022

Last updated

Apr 19, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Kedzuf-McGinnis, ODNPI 1134216609

Title

Optometrist

Phone

(918) 520-4344

Specialties & licenses 1

Addresses

Other names 1

• Cleveland Vision Center Doing business as

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 1

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.

• Lisa Marie Kedzuf-McGinnis, O.D.

  • Optometrist
  • Cleveland, OK
  • NPI 1134216609
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1654473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713484800000",
    "number": "1376272369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9318 SCARLET OAK DR",
            "city": "SAND SPRINGS",
            "state": "OK",
            "postal_code": "740633901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 S BROADWAY ST",
            "city": "CLEVELAND",
            "state": "OK",
            "postal_code": "740204614",
            "telephone_number": "918-385-2245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEDZYMAC ENTERPRISES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-06",
        "last_updated": "2024-04-19",
        "certification_date": "2022-06-14",
        "status": "A",
        "authorized_official_last_name": "KEDZUF-MCGINNIS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "918-520-4344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cleveland Vision Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Cleveland Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Danean Ingram
• Sarah Jabr, LMSW
• Ivy Johnson, BT
• Marlea Kauffman
• Lisa Marie Kedzuf-McGinnis, O.D.
• Aiden Kelley
• Lakisha D Knuckles
• Karley Koch, DO
• Jack Koszykowski, DDS
• Paul Kuncl

• Optometrist in Cleveland, OK
• Providers in Cleveland, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.