Kenneth Alan Otto Jr., MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301403805 Issued in MI

Practice address

1266 E Sherman Blvd
Muskegon, MI 49444-1847

Phone

(231) 739-9009

Fax

(231) 733-0566

NPI assigned

Nov 9, 2005

Last updated

Oct 12, 2020By 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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1131494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602460800000",
    "number": "1164403838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1266 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441847",
            "telephone_number": "231-739-9009",
            "fax_number": "231-733-0566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1266 E SHERMAN BLVD",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "494441847",
            "telephone_number": "231-739-9009",
            "fax_number": "231-733-0566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTO",
        "first_name": "KENNETH",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-09",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301403805",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Srdjan Andrei Ostric, MD
• Emma Sue Ottman, PA-C
• Benjamin Otto, DO
• Brooklyn Pierce Otto, PA-C
• Jessika Otto
• Samantha Oudsema, PHARMD
• Rachael Overkamp, BSW
• Gary L Oxendale, LMSW
• Robert Charles Packer, MD
• Miss-Shavon Elaine Paggett

• Ophthalmology Physician in Muskegon, MI
• Providers in Muskegon, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.