Kelly Duff Visentine, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4924TG Issued in TX

Practice address

3551 Justin Rd Ste 150
Flower Mound, TX 75028-6213

Phone

(972) 355-5152

Fax

(972) 691-2958

NPI assigned

May 12, 2009

Sex

Female

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 TX

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

Specialty

Optometry

Education

Southern California College of Optometry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Texas Professional PLLCGroup PAC ID 4486985678, 228 clinicians

Practice addresses (Care Compare)

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.

• Aeg Texas Professional PLLC

  • Optometrist
  • Kerrville, TX
  • NPI 1457905937
  Medicare reassignment Care Compare group NPD
• Village Vision Center, PLLC

  • Optometrist
  • Highland Village, TX
  • NPI 1841742558
  NPD
• Aeg 7 TX Professional, PLLC

  • Optometrist
  • Flower Mound, TX
  • NPI 1124882659
  NPD (past)

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

{
    "created_epoch": "1242086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612310400000",
    "number": "1396979944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3106 WOODHOLLOW DR",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750228475",
            "telephone_number": "972-259-0052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 JUSTIN RD STE 150",
            "city": "FLOWER MOUND",
            "state": "TX",
            "postal_code": "750286213",
            "telephone_number": "972-355-5152",
            "fax_number": "972-691-2958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VISENTINE",
        "first_name": "KELLY",
        "middle_name": "DUFF",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-05-12",
        "last_updated": "2021-02-03",
        "certification_date": "2021-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "4924TG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vibe Counseling and Wellness
• Aaron Montgomery Vickers, DDS, MD
• Dusty Lynne Vigil, MS, LPC, LCDC
• Village Counseling LLC
• Raul Villalon Jr., MD
• Vision Plaza
• Visionary Family Eye Care PLLC
• Vita I V LLC
• Laura Vogel, PHD
• Kristin L Volck, LPC

• All providers in Flower Mound, TX
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.