Kenneth L. Stack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV004607-1 Issued in NY

Practice address

24 Rosemont St
Albany, NY 12203-2405

Phone

(518) 438-6669

Fax

(518) 489-4372

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

Yes

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 NY

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

Specialty

Optometry

Education

State University of New York - State College Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Kenneth L. Stack Optometrist, PC

  • Optometrist
  • Albany, NY
  • NPI 1760669485
  Medicare reassignment NPD Authorized official
• Afcornell Opticians Inc

  • Optician
  • Ravena, NY
  • NPI 1558544171

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319414400000",
    "number": "1093756371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 ROSEMONT ST",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122032405",
            "telephone_number": "518-438-6669",
            "fax_number": "518-489-4372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 ROSEMONT ST",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122032405",
            "telephone_number": "518-438-6669",
            "fax_number": "518-489-4372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STACK",
        "first_name": "KENNETH",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2011-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV004607-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "931291",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• St. Peters Health Partners Medical Associates PC
• St. Peters Hospital of the City of Albany
• Mark Joseph St.Croix, OTR/L
• Melissa Staats, LMSW
• Katelyn Rose Stack, FNP-BC
• Margaret L Stack, PHARM.D.
• Emily Stadnik
• Laura Ellen Staff, MD
• Frederick W Stafford III
• Shana Elayne Stage

• Optometrist in Albany, NY
• Providers in Albany, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.