Individual provider Active NPI

Kevin La, OD

  • Optometrist
  • Saint Louis, MO
National Provider Identifier
1407544166
Registry record updated Apr 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2023032623 Issued in MO
Practice address
4901 Forest Park Ave
Dept Ophthalmology, 6TH FL
Saint Louis, MO 63108-1495
Phone
(314) 362-3937
Fax
(314) 362-3725
NPI assigned
Apr 28, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2023032623 MO Primary

Addresses

Primary practice location

4901 Forest Park Ave
Dept Ophthalmology, 6TH FL
Saint Louis, MO 63108-1495

Mailing address

PO Box 60352
Saint Louis, MO 63160-0352
Phone (314) 362-3937

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/ Washington University

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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

Enrollment IDStateProvider typePAC IDDetails
I20240805002969 WA Practitioner - Optometry 2961850771 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of California - School of Optometry, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aeg Washington Professional PCGroup PAC ID 3476927997, 61 clinicians

Practice addresses (Care Compare)

3202 W McGraw St
Seattle, WA 98199-3208
Phone (206) 284-5850

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kirkland Eye Clinic, P.S. Optometrist CurrentSince Jul 24, 2024 Accepting new patients
Aeg Washington Professional PC Optometrist CurrentSince Jan 27, 2025 Accepting new patients

Locations

12310 NE 8th St
Ste 101
Bellevue, WA 98005
Phone (425) 455-0001

18209 Bothell Way NE
Bothell, WA 98011
Phone (425) 486-2121

14050 Juanita Dr NE
Ste A
Kirkland, WA 98034
Phone (425) 242-8974

1098 Alder Ave
Marysville, WA 98270
Phone (360) 659-6255

3202 W McGraw St
Seattle, WA 98199
Phone (206) 284-5850

17924 140th Ave NE
Ste 200
Woodinville, WA 98072
Phone (425) 483-8000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1682640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714003200000",
    "number": "1407544166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60352",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631600352",
            "telephone_number": "314-362-3937",
            "fax_number": "314-362-3725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4901 FOREST PARK AVE",
            "address_2": "DEPT OPHTHALMOLOGY, 6TH FL",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631081495",
            "telephone_number": "314-362-3937",
            "fax_number": "314-362-3725"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LA",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-28",
        "last_updated": "2024-04-25",
        "certification_date": "2023-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2023032623",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/",
            "affiliation": "Y",
            "affiliationName": "Washington University",
            "address_1": "4901 Forest Park Ave",
            "address_2": "Dept Ophthalmology, 6th Fl",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631081495",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

Verify at the official NPI Registry.