Kyle W Kelly, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1309-3 Issued in KS

Practice address

2301 10TH Ave
Leavenworth, KS 66048-4214

Phone

(913) 682-2929

Fax

(913) 682-2999

NPI assigned

Aug 9, 2005

Last updated

Jul 8, 2007By the provider in NPPES

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

Enrolled in KS

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Wyandotte Family Eyecare Center, LLC

  • Optometrist
  • Kansas City, KS
  • NPI 1306181367
  Medicare reassignment NPD

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1144221672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 10TH AVE",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660484214",
            "telephone_number": "913-682-2929",
            "fax_number": "913-682-2999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 10TH AVE",
            "city": "LEAVENWORTH",
            "state": "KS",
            "postal_code": "660484214",
            "telephone_number": "913-682-2929",
            "fax_number": "913-682-2999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KELLY",
        "first_name": "KYLE",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1309-3",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1002187108",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Kehr, PHARMD
• Ingrid Keleti, MD
• Tammy Keller
• Dee Anna Kelley
• Jayden Kelley
• Jennifer Lynn Kembel, COTA/L
• Laura Catherine Kemboi, BSN, PMHNP
• Jeffery Richard Kendall
• Yolanda Jolean Kenney
• Atabak Asvadi Kermani, MD

• Optometrist in Leavenworth, KS
• Providers in Leavenworth, KS by specialty
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.