Active NPI
Kenneth L Thomas, O.D.
- Optometrist
- Stockton, CA
National Provider Identifier
1124115506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 5472T
- Practice address
- 1372 W Robinhood Dr
Suite D
Stockton, CA 95207-5513 - Phone
- (209) 477-4414
- Fax
- (209) 477-0159
- NPI assigned
- Oct 6, 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 | 5472T | CA | Primary |
Addresses
Primary practice location
1372 W Robinhood Dr
Suite D
Stockton, CA 95207-5513
Mailing address
1372 W Robinhood Dr
Suite D
Stockton, CA 95207-5513
Phone (209) 477-4414
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| SD0054720 | Medicaid | CA |
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 |
|---|---|---|---|
| 5472T | CA | MD | Optometrist |
| 5472 | CA | MD | Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1207180800000",
"number": "1124115506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1372 W ROBINHOOD DR",
"address_2": "SUITE D",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952075513",
"telephone_number": "209-477-4414",
"fax_number": "209-477-0159"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1372 W ROBINHOOD DR",
"address_2": "SUITE D",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952075513",
"telephone_number": "209-477-4414",
"fax_number": "209-477-0159"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THOMAS",
"first_name": "KENNETH",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-06",
"last_updated": "2008-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CA",
"license": "5472T",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "SD0054720",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.