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General NPI Number Information
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NPI Number | 1508870437
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Entity Type | Individual
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Provider Name | TODD ALAN KENMORE O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/28/2006
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Last Update Date | 02/07/2008
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Provider Practice Location Address
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Address Line | 513 N TELEPHONE RD
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City | MOORE
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State | OK
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Zip | 73160-4938
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Country | US
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Telephone | 405-799-3030
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Fax | 405-799-3737
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Provider Business Mailing Address
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Address Line | 513 N TELEPHONE RD
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City | MOORE
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State | OK
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Zip | 73160-4938
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Country | US
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Telephone | 405-799-3030
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Fax | 405-799-3737
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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 | 2366
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | 2366
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 152WL0500X
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Taxonomy Name | Low Vision Rehabilitation Optometrist
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License Number | 2366
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License Number State | OK
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Taxonomy #4
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | 2366
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License Number State | OK
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Taxonomy #5
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Taxonomy Code | 152WS0006X
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Taxonomy Name | Sports Vision Optometrist
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License Number | 2366
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License Number State | OK
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Taxonomy #6
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 2366
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License Number State | OK
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Taxonomy #7
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | 2366
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License Number State | OK
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Taxonomy #8
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2366
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License Number State | OK
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Taxonomy #9
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 2366
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License Number State | OK
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