Individual provider Active NPI

Kristin Renee Cerni, O.D.

  • Optometrist
  • Chandler, AZ
National Provider Identifier
1053470831
Registry record updated Jan 31, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1285 Issued in AZ
Practice address
220 N McKemy Ave
Chandler, AZ 85226-2654
Phone
(480) 518-1697
NPI assigned
Dec 7, 2006
Last updated
Jan 31, 2014By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 31, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1285 AZ Primary

Addresses

Primary practice location

220 N McKemy Ave
Chandler, AZ 85226-2654

Mailing address

220 N McKemy Ave
Chandler, AZ 85226-2654

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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
I20240528003491 CA Practitioner - Optometry 0547369647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Healthy Eyes Optometry IncGroup PAC ID 5698956449, 6 clinicians

Practice addresses (Care Compare)

1287 Broadway
Placerville, CA 95667-5820
Phone (530) 622-1711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1285AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Healthy Eyes Optometry Inc Optometrist CurrentSince May 18, 2024 Accepting new patients
Dr. Kenneth O'Daniel & Assoc., PC Optometrist PastSince Mar 29, 2017 Accepting new patients
Corydon G Edgecomb OD Inc Optometrist PastSince May 18, 2024 Accepting new patients

Locations

4917 Golden Foothill Pkwy
Ste A
El Dorado Hills, CA 95762
Phone (916) 934-2689

2690 E Bidwell St
Ste 500
Folsom, CA 95630
Phone (916) 549-6728

1287 Broadway
Placerville, CA 95667
Phone (530) 622-1711

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.

NPI Registry JSON

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

{
    "created_epoch": "1165449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391126400000",
    "number": "1053470831",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N MCKEMY AVE",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852262654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N MCKEMY AVE",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "852262654",
            "telephone_number": "480-518-1697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CERNI",
        "first_name": "KRISTIN",
        "middle_name": "RENEE",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-07",
        "last_updated": "2014-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.