=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841461902
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARION M. KENNEY, O.D.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2008
-----------------------------------------------------
Last Update Date | 04/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7643 RIVERS AVE SUITE D
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-797-0737
-----------------------------------------------------
Fax | 843-797-7098
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7643 RIVERS AVE SUITE D
-----------------------------------------------------
City | NORTH CHARLESTON
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29406-4073
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-797-0737
-----------------------------------------------------
Fax | 843-797-7098
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. MARION MANCE KENNEY
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 843-797-0737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | SC0760
-----------------------------------------------------
License Number State | SC
-----------------------------------------------------