Kevin Dean Blair, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2396AT Issued in OR

Practice address

2330 Heritage Way SE
Albany, OR 97322-8600

Phone

(541) 926-6077

Fax

(541) 926-0605

NPI assigned

Mar 16, 2006

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OR

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Waldport Eye Care LLC

  • Optometrist
  • Waldport, OR
  • NPI 1366633679
  NPD (past) Authorized official
• Polk Vision Clinics Inc.

  dba Central Vision Clinic

  • Optometrist
  • Dallas, OR
  • NPI 1760669733
  NPD (past)

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

{
    "created_epoch": "1142467200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1023087525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2330 HERITAGE WAY SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973228600",
            "telephone_number": "541-926-6077",
            "fax_number": "541-926-0605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2330 HERITAGE WAY SE",
            "city": "ALBANY",
            "state": "OR",
            "postal_code": "973228600",
            "telephone_number": "541-926-6077",
            "fax_number": "541-926-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIR",
        "first_name": "KEVIN",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-16",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2396AT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "116850",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anthony Bistodeau, O.D.
• Cynthia Jean Bitz, M.A. CCC-SLP
• Bizzy Bee Massage LLC
• Jeff L Blackford
• Brice Blahnik, DDS
• Kristofer Richard Blankenship, CRM, CADC-R
• Chloe Bliss
• Timothy Eldon Blumer, D.O.
• Linda Renee Bockheim
• Michael Boggess, PH.D.

• Optometrist in Albany, OR
• Providers in Albany, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.