Kellen Robertson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD60649654 Issued in WA

Practice address

412 E 30TH Ave
Spokane, WA 99203-2556

Phone

(509) 448-7300

Fax

(509) 448-7382

NPI assigned

Dec 21, 2015

Sex

Male

Sole proprietor

Yes

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 WA

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyes for Life P SGroup PAC ID 7214989755, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Eyes for Life PS

  • Optometrist
  • Spokane, WA
  • NPI 1023299856
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1285099093",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 E 30TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992032556",
            "telephone_number": "509-448-7300",
            "fax_number": "509-448-7382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 E 30TH AVE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992032556",
            "telephone_number": "509-448-7300",
            "fax_number": "509-448-7382"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1295 Driscoll Ridge Rd",
            "address_purpose": "LOCATION",
            "city": "Troy",
            "state": "ID",
            "postal_code": "838719603",
            "country_code": "US",
            "telephone_number": "208-669-0015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "KELLEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-12-21",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD60649654",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2075649",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carla Robertson, DPT
• Craig I Robertson, PA-C
• Emily Jane Robertson, CRNA
• Jaelynn Lee Robertson
• Karen Ann Robertson, P.T.
• James Andrew Robeson, PHARMD
• Nicole Robideaux, 60712274
• Martin Lucas Robinette
• Christian Michael Erick Robins, MD
• Edwin D Robins, MD

• Optometrist in Spokane, WA
• Providers in Spokane, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.