Provider Demographics
NPI:1720531064
Name:MCWHORTER, MAKENZIE L (OD)
Entity type:Individual
Prefix:DR
First Name:MAKENZIE
Middle Name:L
Last Name:MCWHORTER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:103 CHERA LYNN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-3142
Mailing Address - Country:US
Mailing Address - Phone:606-878-7500
Mailing Address - Fax:606-878-8005
Practice Address - Street 1:103 CHERA LYNN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3142
Practice Address - Country:US
Practice Address - Phone:606-878-7500
Practice Address - Fax:606-878-8005
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2021DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist