Warren Leigh Kennedy, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

6390TPA Issued in CA

Practice address

1401 Sylvan Ave
Modesto, CA 95355-1367

Phone

(209) 527-6640

Fax

(209) 527-5489

NPI assigned

Nov 2, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kennedy and Young OptometryGroup PAC ID 6507810967, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kennedy & Young Optometry

  • Optometrist
  • Modesto, CA
  • NPI 1912119942
  Medicare reassignment Care Compare group NPD
• Kennedy & Young Optometry

  • Optometrist
  • Modesto, CA
  • NPI 1639744238
  NPD (past)

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346889600000",
    "number": "1629069307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551367",
            "telephone_number": "209-527-6640",
            "fax_number": "209-527-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 SYLVAN AVE",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953551367",
            "telephone_number": "209-527-6640",
            "fax_number": "209-527-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "WARREN",
        "middle_name": "LEIGH",
        "name_prefix": "Mr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-02",
        "last_updated": "2012-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "6390TPA",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAL EYE SERVICES",
            "identifier": "12100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Kendrick, M.D,
• Kennedy & Young Optometry
• Kennedy & Young Optometry
• Barbara Kennedy-Funtila, MD
• Donavan Kennedy
• Kenneth D Thompson DDS Inc
• Jennifer Jo'L Kennon
• Christine Kenyon
• Erik L. Kenyon, DPM
• Katie Keo

• Optometrist in Modesto, CA
• Providers in Modesto, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.