Kenneth Kisamore, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA0917 Issued in MD

Practice address

14929 Shady Grove Rd Unit K
Rockville, MD 20850-7728

Phone

(301) 424-1050

Fax

(301) 424-3184

NPI assigned

Jun 13, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in DC, VA2 enrollments

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 2

Specialty

Optometry

Education

Pennsylvania State University College of Medicine, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rockville Optometry, LLCGroup PAC ID 8729180112, 5 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Rockville Optometry, LLC

  • Optometrist
  • Rockville, MD
  • NPI 1548325798

  DC, Optometrist

  Medicare reassignment Care Compare group NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Clinton, MD
  • NPI 1497124796

  DC, Optometrist

  Medicare reassignment NPD
• Dulles Optometry, LLC

  • Optometrist
  • Sterling, VA
  • NPI 1699956136
  Medicare reassignment NPD
• Myeyedr Optometry of Virginia PLLC

  • Optometrist
  • Ashburn, VA
  • NPI 1174933691
  Medicare reassignment NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • College Park, MD
  • NPI 1366086084
  NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Laurel, MD
  • NPI 1972900058
  NPD
• Myeyedr Optometry of Virginia, PLLC

  • Optometrist
  • North Chesterfield, VA
  • NPI 1932075983
  NPD
• Silver Spring Optometry, LLC

  • Optometrist
  • Silver Spring, MD
  • NPI 1336204387
  NPD (past)

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721779200000",
    "number": "1154364800",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8614 WESTWOOD CENTER DR FL 9",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221822442",
            "telephone_number": "703-847-8899",
            "fax_number": "866-795-4020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14929 SHADY GROVE RD UNIT K",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208507728",
            "telephone_number": "301-424-1050",
            "fax_number": "301-424-3184"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1841 Fountain Dr",
            "address_purpose": "LOCATION",
            "city": "Reston",
            "state": "VA",
            "postal_code": "201903326",
            "country_code": "US",
            "telephone_number": "703-264-2020",
            "fax_number": "703-481-9474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KISAMORE",
        "first_name": "KENNETH",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-07-24",
        "certification_date": "2024-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618001710",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA0917",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Kirchoff, PHARMD, MS, MBA
• Robert D Kirkcaldy, MD
• Lauren Kirkpatrick
• Sara Kirkpatrick, CCC-SLP
• Emma Kirschner
• Rebecca Kisamore
• Brianna Kiser
• Steven Robert Kishter, M.D., D.D.S.
• Margot Kissinger
• Kristina Kissiova

• All providers in Rockville, MD
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2024; 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.
• 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.