Active NPI
Kirk C Whittlesey
- Optometrist
- Humboldt, IA
National Provider Identifier
1407840754
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1581
- Practice address
- 12 Taft St S
Humboldt, IA 50548-2037 - Phone
- (515) 332-2950
- Fax
- (515) 332-4451
- NPI assigned
- Sep 1, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1581 | IA | Primary |
Addresses
Primary practice location
12 Taft St S
Humboldt, IA 50548-2037
Mailing address
P O Box 648
12 Taft St S
Humboldt, IA 50548-2037
Phone (515) 332-2950
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0226282 | Medicaid | IA | |
| 1581 | Other | ALL OTHER HEALTH CARE | |
| 2262820 | Other | IA | BCBS |
| 410012199 | Other | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1581 | IA | MD | Optometrist |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Durable Medical Equipment & Medical Supplies
- Humboldt, IA
- NPI 1750550653
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125532800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1352937600000",
"number": "1407840754",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P O BOX 648",
"address_2": "12 TAFT ST S",
"city": "HUMBOLDT",
"state": "IA",
"postal_code": "505482037",
"telephone_number": "515-332-2950",
"fax_number": "515-332-4451"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12 TAFT ST S",
"city": "HUMBOLDT",
"state": "IA",
"postal_code": "505482037",
"telephone_number": "515-332-2950",
"fax_number": "515-332-4451"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITTLESEY",
"first_name": "KIRK",
"middle_name": "C",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-01",
"last_updated": "2012-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "1581",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0226282",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALL OTHER HEALTH CARE",
"identifier": "1581",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "2262820",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "410012199",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Humboldt, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.