Individual provider Active NPI

Kailey Thomas Boynton, OD

  • Optometrist
  • Crossville, TN
National Provider Identifier
1285203547
Registry record updated Oct 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
PENDING Issued in TN
Practice address
15 Iris LN
Crossville, TN 38555-7528
Phone
(931) 456-2728
Fax
(931) 456-5446
NPI assigned
Jun 22, 2021
Last updated
Oct 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X PENDING TN Primary

Addresses

Primary practice location

15 Iris LN
Crossville, TN 38555-7528

Mailing address

15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728

Other practice location 1

3302 Main Street
Pikeville, TN 37367
Phone (423) 556-0808

Other names 1

  • Kailey Elise Thomas Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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

Enrollment IDStateProvider typePAC IDDetails
I20211112000529 TN Practitioner - Optometry 9830588813 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Centers of Tennessee, LLCGroup PAC ID 1355379256, 18 clinicians

Practice addresses (Care Compare)

15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3721TNMDPhysician Assistant
PENDINGTNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Centers of Tennessee, LLC Optometrist Current Accepting new patients
Eye Centers of Tennessee, LLC Optometrist CurrentSince Dec 1, 2021 Accepting new patients
Eye Centers of Tennessee, LLC Optometrist CurrentSince Dec 1, 2021 Accepting new patients

Locations

15 Iris Ln
Crossville, TN 38555
Phone (931) 456-2728

3302 Main St
Pikeville, TN 37367
Phone (423) 556-0808

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1624320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635292800000",
    "number": "1285203547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 IRIS LN",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385557528",
            "telephone_number": "931-456-2728",
            "fax_number": "931-456-5446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 IRIS LN",
            "city": "CROSSVILLE",
            "state": "TN",
            "postal_code": "385557528",
            "telephone_number": "931-456-2728",
            "fax_number": "931-456-5446"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3302 Main Street",
            "address_purpose": "LOCATION",
            "city": "Pikeville",
            "state": "TN",
            "postal_code": "37367",
            "country_code": "US",
            "telephone_number": "423-556-0808",
            "fax_number": "423-556-0809",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOYNTON",
        "first_name": "KAILEY",
        "middle_name": "THOMAS",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-22",
        "last_updated": "2021-10-27",
        "certification_date": "2021-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAILEY",
            "last_name": "THOMAS",
            "middle_name": "ELISE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Crossville, TN

Sources for this page

Verify at the official NPI Registry.