Kendra L. Mahaffey O.D., Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5130/T2029 Issued in OH

Legal business name

KENDRA L. MAHAFFEY O.D., INC.

Practice address

34440 Vine St
Eastlake, OH 44095

Phone

(440) 942-9315

Fax

(440) 942-9374

NPI assigned

Sep 5, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kendra Lea Mahaffey, O.D.

Title

President

Phone

(440) 942-9315

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

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

{
    "created_epoch": "1157414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912009218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3057 LOST NATION RD",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947672",
            "telephone_number": "440-942-9315",
            "fax_number": "440-942-9374"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34440 VINE ST",
            "city": "EASTLAKE",
            "state": "OH",
            "postal_code": "44095",
            "telephone_number": "440-942-9315",
            "fax_number": "440-942-9374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENDRA L. MAHAFFEY O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAHAFFEY",
        "authorized_official_first_name": "KENDRA",
        "authorized_official_middle_name": "LEA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "440-942-9315",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5130/T2029",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Inclusive Care Agency
• Alexandra Intihar
• Dayvionne Jackson
• Amanda D Kashiwsky, PHARMD
• Dez'Aray Keith
• Cansas Lorraine Kincaid, RN
• Tina Maria Komorowski, LPN
• Amanda Kravochuck
• Jennifer Krupa
• Mylee Olivia Lavalais

• Optometrist in Eastlake, OH
• Providers in Eastlake, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.