Kent M Daum, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

S-B49TA-200 Issued in AL

Practice address

251 N Bayou St
Mobile, AL 36603-5827

Phone

(251) 690-8894

NPI assigned

Jul 31, 2006

Last updated

May 28, 2013By 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 3

Addresses

Other identifiers 10

Medicare fee-for-service enrollment

Enrolled in AL

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.

• Access Vision Mobile Eye Clinic

  • Optometrist
  • Brierfield, AL
  • NPI 1942199815
  Medicare reassignment NPD
• Landreth & Associates Inc

  dba Tuscaloosa Eye Care

  • Optometrist
  • Northport, AL
  • NPI 1922183722
  Medicare reassignment NPD
• Alabama Sight Conservation Association

  dba Alabama Lions Sight Convervation

  • Optometrist
  • Birmingham, AL
  • NPI 1043688070
  Medicare reassignment
• Mobile County Board of Health

  dba Mobile Medical Van

  • Federally Qualified Health Center (FQHC)
  • Mobile, AL
  • NPI 1659584555
  NPD (past)
• The University of Alabama at Birmingham

  dba UAB Eye Care

  • Optometrist
  • Birmingham, AL
  • NPI 1487677811
  NPD (past)

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369699200000",
    "number": "1245246107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 N BAYOU ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366035827",
            "telephone_number": "251-690-8894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 N BAYOU ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366035827",
            "telephone_number": "251-690-8894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAUM",
        "first_name": "KENT",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2013-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "T73-TA-200",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MA",
            "license": "4903",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-B49TA-200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000059867",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51059952",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "630000013",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "410021238",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "51527365",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1586056",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00477761",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PAYEE NUMBER",
            "identifier": "011846",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI GROUP PAYEE NUMBER",
            "identifier": "1063439065",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VISION SERVICE PLAN",
            "identifier": "A1716 636005396",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daugette Family Health Services, LLC
• Geoffrey Wayne Daugherty, M.D.
• Manuel Preston Daugherty, MD
• Sarrah Ann Daugherty, DMD
• Cody Daum, MD
• Dauphin Optical
• David Formwalt, Psy.D., LLC
• David J Borcicky PC (David Borcicky DPM)
• David Shane Welch DMD PC (Coastal Dental Arts)
• Anna Maria Davidson, PA

• Optometrist in Mobile, AL
• Providers in Mobile, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2013; 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.