Individual provider Active NPI

Kathy Jo McKenzie, O.D.

  • Optometrist
  • Oklahoma City, OK
National Provider Identifier
1861503823
Registry record updated Dec 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1112 Issued in OK
Practice address
1000 SW 44TH St
Suite 300
Oklahoma City, OK 73109-3630
Phone
(405) 634-2471
Fax
(405) 634-1374
NPI assigned
Aug 31, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 8, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1112 OK Primary

Addresses

Primary practice location

1000 SW 44TH St
Suite 300
Oklahoma City, OK 73109-3630

Mailing address

1000 SW 44TH St
Suite 300
Oklahoma City, OK 73109-3630
Phone (405) 634-2471

Other identifiers 2

IdentifierTypeStateIssuer
100765650AMedicaidOK
4994830001OtherOKDMEPOS, PALMETTO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20031213000045 OK Practitioner - Optometry 5890692388 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1000 SW 44TH St
Suite 300
Oklahoma City, OK 73109-3629
Phone (405) 634-2471

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1112OKMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Kathy J. McKenzie, O.D., Inc. Optometrist CurrentSince Jan 31, 2003 Accepting new patients

Locations

1024 SW 44th St
Ste 700
Oklahoma City, OK 73109
Phone (405) 631-9625

1000 SW 44th St
Ste 300
Oklahoma City, OK 73109
Phone (405) 602-6284

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1323302400000",
    "number": "1861503823",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 SW 44TH ST",
            "address_2": "SUITE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093630",
            "telephone_number": "405-634-2471",
            "fax_number": "405-634-1374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 SW 44TH ST",
            "address_2": "SUITE 300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731093630",
            "telephone_number": "405-634-2471",
            "fax_number": "405-634-1374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "KATHY",
        "middle_name": "JO",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2011-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "1112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100765650A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMEPOS, PALMETTO",
            "identifier": "4994830001",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

Verify at the official NPI Registry.