Active NPI
Kendyl King
- Optician
- Cambridge, OH
National Provider Identifier
1306689047
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- OP017750S
- Practice address
- 61205 Southgate Rd
Cambridge, OH 43725-8002 - Phone
- (740) 439-5444
- Fax
- (740) 439-9785
- NPI assigned
- Jun 18, 2024
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Optician | 156FX1800X | OP017750S | OH | Primary |
Addresses
Primary practice location
61205 Southgate Rd
Cambridge, OH 43725-8002
Mailing address
61205 Southgate Rd
Cambridge, OH 43725-8002
Phone (740) 439-5444
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OP017750S | OH | MD | Optician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | 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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718668800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1718668800000",
"number": "1306689047",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61205 SOUTHGATE RD",
"city": "CAMBRIDGE",
"state": "OH",
"postal_code": "437258002",
"telephone_number": "740-439-5444",
"fax_number": "740-439-9785"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "61205 SOUTHGATE RD",
"city": "CAMBRIDGE",
"state": "OH",
"postal_code": "437258002",
"telephone_number": "740-439-5444",
"fax_number": "740-439-9785"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "KENDYL",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-06-18",
"last_updated": "2024-06-18",
"certification_date": "2024-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Technician/Technologist, Optician",
"state": "OH",
"license": "OP017750S",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Cambridge, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.