Kenneth R Moultrie, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

S536TA063 Issued in AL

Practice address

600 Washington St NW
Huntsville, AL 35801-4751

Phone

(256) 533-6838

Fax

(256) 533-1910

NPI assigned

Feb 3, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmoultrie@direct.eyecare-partners.com

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.

• Eyecare Associates, Inc.

  • Eyewear Supplier
  • Birmingham, AL
  • NPI 1710012877

  Optometrist

  Medicare reassignment NPD
• Eyecare Associates, Inc.

  dba Eyecare Associates -Montgomery 4320

  • Optometrist
  • Montgomery, AL
  • NPI 1871475038
  NPD
• Eyecare Associates, Inc.

  • Eyewear Supplier
  • Huntsville, AL
  • NPI 1992830079

  Optometrist

  NPD
• Eyecare Associates, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Jasper, AL
  • NPI 1255490041
  NPD (past)

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

{
    "created_epoch": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485993600000",
    "number": "1376515361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15933 CLAYTON RD",
            "address_2": "SUITE 201",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630112172",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WASHINGTON ST NW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358014751",
            "telephone_number": "256-533-6838",
            "fax_number": "256-533-1910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULTRIE",
        "first_name": "KENNETH",
        "middle_name": "R",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-03",
        "last_updated": "2017-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S536TA063",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stephanie Nicole Mott, CRNP
• Troy Elijah Mott, M.D.
• Tracy M Motyka, MD
• Krista Ann Moulton, LICSW
• Brianna Michelle Moultrie
• Anthony Raymond Mountain I
• MTM Services of Alabama,Inc. (Sterling Compounding Pharmacy)
• Maryam Salam Muayad, MD
• Michael L. Mueller, M.D.
• Sarah Elizabeth Mulder

• Optometrist in Huntsville, AL
• Providers in Huntsville, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2017; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.