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General NPI Number Information
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NPI Number | 1275506180
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Entity Type | Individual
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Provider Name | MARION MANCE KENNEY O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 11/22/2017
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Provider Practice Location Address
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Address Line | 7643 RIVERS AVE SUITE D
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City | NORTH CHARLESTON
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State | SC
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Zip | 29406-4073
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Country | US
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Telephone | 843-797-0731
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Fax | 843-797-7098
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Provider Business Mailing Address
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Address Line | 324 SHAFTESBURY LN
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City | SUMMERVILLE
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State | SC
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Zip | 29485-8557
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Country | US
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Telephone | 843-871-0684
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Fax | 843-797-7098
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0760
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License Number State | SC
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