Kevin M Gardner, OD
Individual provider Active NPI Optometrist · Joplin, MO
NPI 1346358769 · NPPES record last updated Nov 20, 2023
Key facts
- NPI
- 1346358769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- TO3487 (MO)
- Practice address
- 1531 W 32ND Street
Suite 102
Joplin, MO 64804-1651 - Phone
- (417) 781-3630
- Fax
- (417) 781-9814
- NPI assigned
- Aug 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 7
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Missouri St Louis - School of Optometry, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Gracie Chase Avery LLC
Practice addresses (Care Compare)
1701 W 26TH St
Joplin, MO 64804-1513
Phone (417) 952-2366
411 E Centennial Dr
Pittsburg, KS 66762-6505
Phone (620) 323-1005
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 23 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in MO, AR, KS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070525000026 | MO | Practitioner - Optometry | 5294832200 | Reassigns benefits to 1 organization |
| I20101118000151 | AR | Practitioner - Optometry | 5294832200 | Reassigns benefits to 1 organization |
| I20210722003949 | KS | Practitioner - Optometry | 5294832200 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2653 | AR | MD | Optometrist |
| TO3487 | MO | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gracie Chase Avery, LLC | Optometrist | Current |
Accepting new patients |
| Piper'S Vision Xpress, LLC | Optometrist | Current |
Accepting new patients |
| Wimmer P.a. | Optometrist | Current |
Accepting new patients |
| Midwest Eye Associates, Inc. | Optometrist | Past |
Accepting new patients |
| Gary D. Neymeyer, O.D., P.C. | Optometrist | Past | Accepting new patients |
| Lewis Optical, Inc | Past | Accepting new patients | |
| Vold Vision PLLC | Optometrist | Past | Accepting new patients |
Locations
50 Paul Wood Ln
Mountain Home, AR 72653
Phone (870) 492-2419
411 E Centennial Dr
Pittsburg, KS 66762
Phone (620) 232-1005
1701 W 26th St
Joplin, MO 64804
Phone (417) 952-2366
1701 W 26th St
#E
Joplin, MO 64804
Phone (417) 925-2366
5265 S Business Highway 71
Ste B
Pineville, MO 64856
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2653 | AR | |
| Optometrist | 152W00000X | TO3487 | MO | Yes |
Addresses
Primary practice location
1531 W 32ND Street
Suite 102
Joplin, MO 64804-1651
Mailing address
1701 W 26TH St Ste E
Joplin, MO 64804-1513
Phone (417) 952-2366
Other providers in Joplin, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 20, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.