Active NPI
Kurtis M. Carlson, O.D.
- Optometrist
- Quincy, IL
National Provider Identifier
1104930601
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 046-008272
- Practice address
- 4929 Oak Street
Quincy, IL 62305-2839 - Phone
- (217) 222-2020
- Fax
- (217) 223-9582
- NPI assigned
- Aug 19, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 046-008272 | IL | Primary |
Addresses
Primary practice location
4929 Oak Street
Quincy, IL 62305-2839
Mailing address
4929 Oak Street
Quincy, IL 62305
Phone (217) 222-2020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 132031 | Other | IL | BLUE CROSS BLUE SHIELD |
| 258761 | Other | IL | HEALTHLINK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046-008272 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christina J. Levi O D P C | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Edwardsville, IL
- NPI 1033261904
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1432857600000",
"number": "1104930601",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4929 OAK STREET",
"city": "QUINCY",
"state": "IL",
"postal_code": "62305",
"telephone_number": "217-222-2020",
"fax_number": "217-223-9582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4929 OAK STREET",
"city": "QUINCY",
"state": "IL",
"postal_code": "623052839",
"telephone_number": "217-222-2020",
"fax_number": "217-223-9582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "KURTIS",
"middle_name": "M.",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-19",
"last_updated": "2015-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IL",
"license": "046-008272",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "132031",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHLINK",
"identifier": "258761",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Quincy, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.