Justin William Davenport, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2006022079 Issued in MO

Practice address

400 NW Barry Rd
Kansas City, MO 64155-2725

Phone

(816) 468-6006

Fax

(816) 436-0924

NPI assigned

Oct 16, 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 MO

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

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.

• Visionworks, Inc.

  • Optometrist
  • Independence, MO
  • NPI 1649203308
  Medicare reassignment NPD
• Visionworks, Inc

  • Eyewear Supplier
  • Simpsonville, SC
  • NPI 1699571166
  NPD

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1376623462",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11103 WEST AVE",
            "address_2": "STE 6",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782131370",
            "telephone_number": "210-524-6803",
            "fax_number": "210-524-6587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 NW BARRY RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641552725",
            "telephone_number": "816-468-6006",
            "fax_number": "816-436-0924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVENPORT",
        "first_name": "JUSTIN",
        "middle_name": "WILLIAM",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2006022079",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kathryn Colleen Daugherty
• Nathaniel Daugherty, PHARMD
• Philip Dauma, MD
• Raghuvardhan Davalapur, MD
• Aditi Ashvin Dave, M.D.
• Stephanie Lea Davenport, RN
• Ashton Davey
• David E Wilson MD LLC
• David G. Smithson, MD PC
• David P Ehman PHD LLC

• Optometrist in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.