MEDICARE: DR. MARION MANCE KENNEY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0760	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275506180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARION MANCE KENNEY O.D.

Provider Business Mailing Address
First Line	:	324 SHAFTESBURY LN
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-8557
Country	:	US
Telephone Number	:	843-871-0684
Fax Number	:	843-797-7098

Provider Business Practice Location Address
First Line	:	7643 RIVERS AVE
Second Line	:	SUITE D
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4073
Country	:	US
Telephone Number	:	843-797-0731
Fax Number	:	843-797-7098

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	11/22/2017

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