Kent M Sieboldt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2120 Issued in FL

Practice address

324 E Bloomingdale Ave
Brandon, FL 33511-8155

Phone

(813) 685-2646

Fax

(813) 681-6821

NPI assigned

Jul 13, 2005

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 FL

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

Indiana University - School of Optometry, 1985

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

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 and National Provider Directory roles.

• Kent M. Sieboldt, OD, PA

  • Optometrist
  • Brandon, FL
  • NPI 1134441132
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266364800000",
    "number": "1295733137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "324 E BLOOMINGDALE AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118155",
            "telephone_number": "813-685-2646",
            "fax_number": "813-681-6821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "324 E BLOOMINGDALE AVE",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335118155",
            "telephone_number": "813-685-2646",
            "fax_number": "813-681-6821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEBOLDT",
        "first_name": "KENT",
        "middle_name": "M",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2010-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "2120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "086169300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Josiah Shively
• Tameem A Shoukih, M.D.
• Anna Shumaker
• Thet Eain Si, RBT
• Sunny Sia, ARNP
• Ira L Siegman, M.D.
• Michael G Siegman, MD
• Ali Sigismondi
• Jeannene Silva
• Luis Daniel Silva, MD

• Optometrist in Brandon, FL
• Providers in Brandon, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2010; 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.