Kevin Langeson Kish, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1673 Issued in MN

Practice address

352 S Main St
Box 38
Zumbrota, MN 55992-0038

Phone

(507) 732-7630

Fax

(507) 732-5401

NPI assigned

Nov 3, 2005

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224115200000",
    "number": "1225029697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "352 S MAIN ST",
            "address_2": "BOX 38",
            "city": "ZUMBROTA",
            "state": "MN",
            "postal_code": "559920038",
            "telephone_number": "507-732-7630",
            "fax_number": "507-732-5401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "352 S MAIN ST",
            "address_2": "BOX 38",
            "city": "ZUMBROTA",
            "state": "MN",
            "postal_code": "559920038",
            "telephone_number": "507-732-7630",
            "fax_number": "507-732-5401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KISH",
        "first_name": "KEVIN",
        "middle_name": "LANGESON",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2008-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "1673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174523900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Zumbrota, MN
• Providers in Zumbrota, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2008; 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.