Kennedy Eyecare LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

2160 Issued in OK

Legal business name

KENNEDY EYECARE LLC

Practice address

1400 Wade Watts Ave
McAlester, OK 74501

Phone

(918) 429-1400

Fax

(918) 429-1403

NPI assigned

Jul 17, 2012

Last updated

Dec 30, 2022By 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

Crystie Leigh Wesley

Title

Office Manager

Phone

(918) 429-1400

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

Other NPIs on the same Medicare enrollment 2

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

• Kennedy Eyecare LLC

  • Optometrist
  • Checotah, OK
  • NPI 1033822135

  O20121031000660

  Same enrollment
• Kennedy Eyecare LLC

  • Optometrist
  • Atoka, OK
  • NPI 1770282444

  O20121031000660

  Same enrollment

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

Tax ID family

Kennedy Eyecare LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Kennedy Eyecare LLC

  • Optometrist
  • Checotah, OK
  • NPI 1033822135
  NPD tax ID
• Kennedy Eyecare LLC

  • Optometrist
  • Atoka, OK
  • NPI 1770282444
  NPD tax ID

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Kennedy Eyecare LLC

  • Optometrist
  • Checotah, OK
  • NPI 1033822135
  NPPES parent name
• Kennedy Eyecare LLC

  • Optometrist
  • Atoka, OK
  • NPI 1770282444
  NPPES parent name

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.

• Catherine F Carlin, O.D.

  • Optometrist
  • Bethany, OK
  • NPI 1902804172
  Medicare reassignment Care Compare group NPD
• Craig Kennedy, OD

  • Optometrist
  • McAlester, OK
  • NPI 1992768113
  Medicare reassignment Care Compare group NPD
• Anna Paige Million, OD

  • Optometrist
  • McAlester, OK
  • NPI 1699404277
  Medicare reassignment Care Compare group NPD
• Michael Alex Million, OD

  • Optometrist
  • McAlester, OK
  • NPI 1568107209
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672358400000",
    "number": "1821343617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 WADE WATTS AVE",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "74501",
            "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": "1400 WADE WATTS AVE",
            "city": "MCALESTER",
            "state": "OK",
            "postal_code": "74501",
            "telephone_number": "918-429-1400",
            "fax_number": "918-429-1403"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "205 W Okmulgee Ave",
            "address_purpose": "LOCATION",
            "city": "Checotah",
            "state": "OK",
            "postal_code": "744262408",
            "country_code": "US",
            "telephone_number": "918-473-2308",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "KENNEDY EYECARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2022-12-30",
        "certification_date": "2022-12-30",
        "status": "A",
        "authorized_official_last_name": "WESLEY",
        "authorized_official_first_name": "CRYSTIE",
        "authorized_official_middle_name": "LEIGH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "918-429-1400"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2160",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200454560A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard Don Kelley
• Linda Carel Kellum, MHR/BHRS
• Carissa Kemp, LPC
• Cindy J Kemp
• Jason Kemp, LPN
• Craig Kennedy, OD
• Warren McKinley Kerby
• Marian Kerns
• Alisha Dawn Ketchum
• Abdolkarim Khorasanchian, MD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2022; 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.