Kenneth Richard Statsick, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2303 Issued in NC

Practice address

2803 Cashwell Dr
Ste a
Goldsboro, NC 27534-4301

Phone

(919) 778-2015

Fax

(919) 778-4808

NPI assigned

Aug 20, 2010

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in NC

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

Nova Southeastern Univ College of Dental Medicine, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Atlantic Eye Optometric Services, P.a..Group PAC ID 1759691710, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Atlantic Eye Optometric Services, P.a.

  • Optometrist
  • Goldsboro, NC
  • NPI 1710353479
  Medicare reassignment Care Compare group Authorized official
• T Gibson Blackman

  dba Atlantic Eye Center

  • Optometrist
  • Goldsboro, NC
  • NPI 1649532870
  NPD (past)

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752624000000",
    "number": "1407162043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2803 CASHWELL DR",
            "address_2": "STE A",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344301",
            "telephone_number": "919-778-2015",
            "fax_number": "919-778-4808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2803 CASHWELL DR",
            "address_2": "STE A",
            "city": "GOLDSBORO",
            "state": "NC",
            "postal_code": "275344301",
            "telephone_number": "919-778-2015",
            "fax_number": "919-778-4808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATSICK",
        "first_name": "KENNETH",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-08-20",
        "last_updated": "2025-07-16",
        "certification_date": "2025-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4549",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NC",
            "license": "2303",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "C374",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12143984",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PIN",
            "identifier": "5922830",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PTAN",
            "identifier": "5922830",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott Douglas Stahle, M.D.
• Christine Eddins Stallings, FNP
• Stephanie Demetrius Stallings, LCSWA
• Victoria Stancil, PTA
• Tara M Staton, MD
• Lindsay Schafer Statsick, OD
• Sarah C. Statsick, OD
• William S. Stauffer, CPO
• Holly Eudora Steele, LPCA
• Harold Brian Stegall, PT

• Optometrist in Goldsboro, NC
• Providers in Goldsboro, NC by specialty
• Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2025; 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.