Kevin Congdon, O. D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2071-035 Issued in WI

Practice address

3003 Cleveland Ave
Suite a
Marinette, WI 54143

Phone

(715) 732-2101

NPI assigned

Mar 22, 2007

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 WI

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

Interoperability endpoints

• Direct secure messaging: kevincongdon@direct.revolutionehr.com

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.

• Congdon Optometry Inc

  • Optician
  • Marinette, WI
  • NPI 1003932088

  Optometrist

  Medicare reassignment NPD

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

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484524800000",
    "number": "1154447134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W1417 AUTUMN WOOD LN",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541439417",
            "telephone_number": "715-732-9110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3003 CLEVELAND AVE",
            "address_2": "SUITE A",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "54143",
            "telephone_number": "715-732-2101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONGDON",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "O. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2017-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2071-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38527200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Churm, MSW LCSW
• Brian Cleven, ATC, LAT, RCEP
• Communication Cabin Inc.
• Congdon Optometry Inc
• Andrew Congdon, O.D.
• Nicole Ann Conklin, PHARMD
• Julie R Conley, PHYSICAL THERAPIST
• Mitchell C Connell, LPC
• Lisa R Cook, NP
• Robert James Cooper, CRNA

• Optometrist in Marinette, WI
• Providers in Marinette, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; 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.