Mary C Kennedy, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT001335 Issued in GA

Practice address

1550 Scenic Hwy N
Snellville, GA 30078-2130

Phone

(770) 979-9456

NPI assigned

Dec 11, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Mary C. Deheck Other name

Medicare fee-for-service enrollment

Enrolled in GA

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881754000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 MILFIELD CIR",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782079",
            "telephone_number": "770-736-6185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1550 SCENIC HWY N",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782130",
            "telephone_number": "770-979-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "MARY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "GA",
            "license": "OPT001335",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "DEHECK",
            "middle_name": "C.",
            "prefix": "MRS.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Millie Kelley, M.A., CCC-A
• Courtney Kelly, RBT
• Kelly Kencade-Pichon
• Andrea M Kennedy
• Katherine A Kennedy, P.A.-C
• Kent M. Mattison, D.M.D., P.C.
• Lindsay Michelle Kent, PTA
• Jennifer L Kephart, SLP
• Usman Manzoor Khalid, M.D.
• Sami Osman Khan, MD

• Optometrist in Snellville, GA
• Providers in Snellville, GA by specialty
• Optometrist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.