Stacy Kennedy, OD
Individual provider Active NPI Optometrist · Harvey, LA
NPI 1720149016 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1720149016
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 715 (LA)
- Practice address
- 1801 Manhattan Blvd
U
Harvey, LA 70058-7300 - Phone
- (504) 367-3930
- NPI assigned
- Dec 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in LA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060425000069 | LA | Practitioner - Optometry | 0941210769 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1103 | LA | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye-Deal Optical, LLC | Optometrist | Current |
Accepting new patients |
| Jason Wonch, O.D. and Associates, a.P.C. | Optometrist | Past | Accepting new patients |
| Respiratory Services Inc | Past |
Accepting new patients |
Locations
3220 General Degaulle Dr
Ste 100
New Orleans, LA 70114
Phone (504) 363-0146
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 715 | LA | Yes |
Addresses
Primary practice location
1801 Manhattan Blvd
U
Harvey, LA 70058-7300
Mailing address
11103 West Ave
Ste 6
San Antonio, TX 78213-1370
Phone (210) 524-6803
Other providers in Harvey, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.