Provider Demographics
NPI:1548491590
Name:DEBERRY, KENDRA L (OD)
Entity type:Individual
Prefix:DR
First Name:KENDRA
Middle Name:L
Last Name:DEBERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5832 BOAT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-7773
Mailing Address - Country:US
Mailing Address - Phone:817-237-7153
Mailing Address - Fax:817-237-7123
Practice Address - Street 1:3963 BOAT CLUB RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3202
Practice Address - Country:US
Practice Address - Phone:817-237-7153
Practice Address - Fax:817-237-7123
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7458T152WL0500X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation