Kent Randall Wolber, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

T02786 Issued in MO

Practice address

175 Shinn LN
Hannibal, MO 63401-6754

Phone

(573) 406-5730

Fax

(573) 406-1369

NPI assigned

Apr 28, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1146182400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1524441600000",
    "number": "1104883560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 SHINN LN",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016754",
            "telephone_number": "573-406-5730",
            "fax_number": "573-406-1369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLBER",
        "first_name": "KENT",
        "middle_name": "RANDALL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-28",
        "last_updated": "2018-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02786",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "312852700",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Willow Garden of Hannibal, LLC
• Ashley Marting Wilson
• Megan E Wilson, PLPC
• Taylor Wilson
• Walter Tyler Winders, M.D.
• Jamie Woodhurst, SLPA
• Emma Lee Wright, DO
• Priyanka Yerragorla, MD, MSC
• Josephine Zerbonia
• Nicolai Zhidkov, MD

• Optometrist in Hannibal, MO
• Providers in Hannibal, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.