Active NPI
Kenneth A Phillips, OD
- Optometrist
- Waymart, PA
National Provider Identifier
1285709626
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG000530
- Practice address
- 314 Honesdale Road
Waymart, PA 18472-0310 - Phone
- (570) 488-6710
- NPI assigned
- Nov 21, 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 | OEG000530 | PA | Primary |
Addresses
Primary practice location
314 Honesdale Road
Waymart, PA 18472-0310
Mailing address
PO Box 310
Waymart, PA 18472-0310
Phone (570) 488-6710
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 075457 | Other | PA | FIRST PRIORITY |
| 390770 | Other | PA | NVA |
| 18765 | Other | PA | GEISINGER |
| OEG000530 | Other | PA | VBA |
| 0829700 | Other | PA | AETNA |
| PH289044 | Other | PA | CLARITY VISION |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Waymart Eyecare | 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.
-
- Optometrist
- Waymart, PA
- NPI 1770024572
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164067200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277942400000",
"number": "1285709626",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 310",
"city": "WAYMART",
"state": "PA",
"postal_code": "184720310",
"telephone_number": "570-488-6710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "314 HONESDALE ROAD",
"city": "WAYMART",
"state": "PA",
"postal_code": "184720310",
"telephone_number": "570-488-6710"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "KENNETH",
"middle_name": "A",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-21",
"last_updated": "2010-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG000530",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST PRIORITY",
"identifier": "075457",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NVA",
"identifier": "390770",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEISINGER",
"identifier": "18765",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VBA",
"identifier": "OEG000530",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "0829700",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLARITY VISION",
"identifier": "PH289044",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Waymart, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.