Active NPI
Kenneth Leon Gortz, O.D.
- Optometrist
- Willard, OH
National Provider Identifier
1295973154
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2891
- Practice address
- 421A E Walton St
Willard, OH 44890-9108 - Phone
- (419) 933-4327
- Fax
- (419) 933-4336
- NPI assigned
- Jan 30, 2009
- Last updated
- Aug 18, 2016
- 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 | 2891 | OH | Primary |
Addresses
Primary practice location
421A E Walton St
Willard, OH 44890-9108
Mailing address
1500 S County Road 1
Tiffin, OH 44883-9746
Phone (419) 443-0710
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 |
|---|---|---|---|
| 2891 | OH | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ohio Hearing Professionals, LLC | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Hearing Instrument Specialist
- Tiffin, OH
- NPI 1215255286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1233273600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1471478400000",
"number": "1295973154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 S COUNTY ROAD 1",
"city": "TIFFIN",
"state": "OH",
"postal_code": "448839746",
"telephone_number": "419-443-0710",
"fax_number": "419-443-0576"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "421A E WALTON ST",
"city": "WILLARD",
"state": "OH",
"postal_code": "448909108",
"telephone_number": "419-933-4327",
"fax_number": "419-933-4336"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GORTZ",
"first_name": "KENNETH",
"middle_name": "LEON",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-01-30",
"last_updated": "2016-08-18",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "2891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Willard, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.