Healthcare Provider Details

I. General information

NPI: 1831010107
Provider Name (Legal Business Name): CARLYE ELIZABETH KENNEDY OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 W LIBERTY RD
ATOKA OK
74525-1705
US

IV. Provider business mailing address

1400 E WADE WATTS AVE
MCALESTER OK
74501-5652
US

V. Phone/Fax

Practice location:
  • Phone: 580-292-0144
  • Fax: 580-292-0142
Mailing address:
  • Phone: 918-429-1400
  • Fax: 918-429-1403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3348
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: