Provider Demographics
NPI:1194125468
Name:MCDONALD, KERINNA MOLLY (OD)
Entity type:Individual
Prefix:DR
First Name:KERINNA
Middle Name:MOLLY
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:KERINNA
Other - Middle Name:MOLLY
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:4101 BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-2858
Mailing Address - Country:US
Mailing Address - Phone:718-428-6700
Mailing Address - Fax:
Practice Address - Street 1:4101 BELL BLVD
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2858
Practice Address - Country:US
Practice Address - Phone:718-428-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-24
Last Update Date:2014-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008157-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist