MEDICARE: MARION M. 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	SC0760	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	:	1841461902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARION M. KENNEY, O.D.

Provider Business Mailing Address
First Line	:	7643 RIVERS AVE
Second Line	:	SUITE D
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4073
Country	:	US
Telephone Number	:	843-797-0737
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	:	843-797-0737
Fax Number	:	843-797-7098

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARION MANCE KENNEY
Credential	:	O.D.
Telephone Number	:	843-797-0737

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	04/30/2008

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