Active NPI
Donald Ray Kelle, O.D.
- Optometrist
- Ponca City, OK
National Provider Identifier
1265520951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 937
- Practice address
- 200 White Eagle Dr
Ponca City, OK 74601-8315 - Phone
- (580) 765-2501
- Fax
- (580) 765-6348
- NPI assigned
- Oct 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 937 | OK | Primary |
Addresses
Primary practice location
200 White Eagle Dr
Ponca City, OK 74601-8315
Mailing address
200 White Eagle Dr
Ponca City, OK 74601-8315
Phone (580) 765-2501
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 937 | OK | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blackwell Vision Center Inc | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349395200000",
"number": "1265520951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 WHITE EAGLE DR",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746018315",
"telephone_number": "580-765-2501",
"fax_number": "580-765-6348"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WHITE EAGLE DR",
"city": "PONCA CITY",
"state": "OK",
"postal_code": "746018315",
"telephone_number": "580-765-2501",
"fax_number": "580-765-6348"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLE",
"first_name": "DONALD",
"middle_name": "RAY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-10",
"last_updated": "2012-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "937",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ponca City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.