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General NPI Number Information
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NPI Number | 1245645720
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Entity Type | Organization
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Legal Business Name | DR. JOHN D. MCKENNA, OPTOMETRIST, LLC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 1511 N POST RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4247
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Country | US
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Telephone | 317-899-1017
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Fax | 317-899-1660
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Provider Business Mailing Address
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Address Line | 1511 N POST RD
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-4247
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Country | US
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Telephone | 317-899-1017
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Fax | 317-899-1660
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. JOHN DAVID MCKENNA II
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Credential | O.D.
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Telephone | 317-899-1017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18003120B
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License Number State | IN
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