Individual provider Active NPI

Robert Kesead Jr., O.D.

  • Optometrist
  • Hurlburt Field, FL
National Provider Identifier
1003879123
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT 9146 Issued in CA
Practice address
113 Lielmanis Ave
Hurlburt Field, FL 32544-5613
Phone
(850) 883-3187
NPI assigned
Apr 10, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT 9146 CA Primary

Addresses

Primary practice location

113 Lielmanis Ave
Hurlburt Field, FL 32544-5613

Mailing address

113 Lielmanis Ave
Hurlburt Field, FL 32544-5613
Phone (850) 883-3187

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080425000254 TX Practitioner - Optometry 7911085303 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pennsylvania College of Optometry, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
DHHS IHS Phoenix AreaGroup PAC ID 0244405629, 54 clinicians
DHHS IHS Phoenix AreaGroup PAC ID 7810163011, 25 clinicians

Practice addresses (Care Compare)

12033 Agency Rd
Parker, AZ 85344-7718
Phone (928) 669-2137

943 Hualapai Way
Peach Springs Health Center
Peach Springs, AZ 86434-0190
Phone (928) 769-2900

943 Hualapai Way P O Box
190 Peach Springs Health Center
Peach Springs, AZ 86434-0190

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
70.2 of 100Reported as group
Quality
74.9
Improvement activities
40
Cost
20.37

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT 9146CAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
DHHS IHS Phoenix CurrentSince Apr 1, 2015 Accepting new patients
DHHS IHS Phoenix Area Current Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1003879123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-883-3187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 LIELMANIS AVE",
            "city": "HURLBURT FIELD",
            "state": "FL",
            "postal_code": "325445613",
            "telephone_number": "850-883-3187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESEAD",
        "first_name": "ROBERT",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OPT 9146",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hurlburt Field, FL

Sources for this page

Verify at the official NPI Registry.