Individual provider Active NPI

Kenneth Mathew Kirkland, OD

  • Optometrist
  • Plano, TX
National Provider Identifier
1053300624
Registry record updated Sep 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
03489TG Issued in TX
Practice address
6909 Coit Rd
Ste 200
Plano, TX 75024-5468
Phone
(972) 208-5757
Fax
(972) 208-5548
NPI assigned
Oct 17, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 03489TG TX Primary

Addresses

Primary practice location

6909 Coit Rd
Ste 200
Plano, TX 75024-5468

Mailing address

6909 Coit Rd
Ste 200
Plano, TX 75024-5468
Phone (972) 208-5757

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
I20100616000420 TX Practitioner - Optometry 0840329793 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Texas Professional PLLCGroup PAC ID 4486985678, 228 clinicians

Practice addresses (Care Compare)

3551 Justin Rd
Suite 150
Flower Mound, TX 75028-6213
Phone (972) 355-5152

6909 Coit Rd
Suite 200
Plano, TX 75024-5470
Phone (972) 208-5757

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
03489TGTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Aeg Texas Professional PLLC Optometrist CurrentSince Jan 2, 2021 Accepting new patients
Janet B Ogletree OD PA Optometrist PastSince Nov 1, 2016 Accepting new patients

Locations

3551 Justin Rd
Ste 150
Flower Mound, TX 75028
Phone (210) 490-9205

6909 Coit Rd
Ste 200
Plano, TX 75024
Phone (972) 208-5757

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222041600000",
    "number": "1053300624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6909 COIT RD",
            "address_2": "STE 200",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750245468",
            "telephone_number": "972-208-5757",
            "fax_number": "972-208-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6909 COIT RD",
            "address_2": "STE 200",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750245468",
            "telephone_number": "972-208-5757",
            "fax_number": "972-208-5548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRKLAND",
        "first_name": "KENNETH",
        "middle_name": "MATHEW",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2008-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "03489TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.