Kent M. Sieboldt, OD, PA

Primary specialty

OptometristTaxonomy code 152W00000X

License

2120 Issued in FL

Legal business name

KENT M. SIEBOLDT, OD, PA

Practice address

324 E Bloomingdale Ave
Brandon, FL 33511-8155

Phone

(813) 685-2646

Fax

(813) 681-6821

NPI assigned

Feb 18, 2010

Last updated

Feb 18, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kent M. Sieboldt, ODNPI 1295733137

Title

President

Phone

(813) 685-2646

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Kent M Sieboldt, O.D.

  • Optometrist
  • Brandon, FL
  • NPI 1295733137
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1266451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1134441132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 E BLOOMINGDALE AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118155",
            "telephone_number": "813-685-2646",
            "fax_number": "813-681-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 E BLOOMINGDALE AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118155",
            "telephone_number": "813-685-2646",
            "fax_number": "813-681-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT M. SIEBOLDT, OD, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-18",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "SIEBOLDT",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-685-2646",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "FL",
            "license": "2120",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonaye Kennedy
• Lorraine Hoyos Kennedy, MD
• Monica S Kennedy, O.D.
• Kenneth W Trussell DC PA
• Kaitlyn Kenny
• Jennifer Hummer Keovongsa, L.M.H.C.
• Dale L Keppley
• Lori Kerrigan, LMHCI
• Lorin Kersting
• Rebecca Sue Kerzan, LMT, CPT

• Optometrist in Brandon, FL
• Providers in Brandon, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.