Individual provider Active NPI

Daniel Kingsley, O.D.

  • Optometrist
  • Farmville, VA
National Provider Identifier
1417063744
Registry record updated Mar 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0618000544 Issued in VA
Practice address
100 N Virginia St
Farmville, VA 23901-1537
Phone
(434) 392-8113
Fax
(434) 392-5934
NPI assigned
Aug 21, 2006
Last updated
Mar 18, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 18, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0618000544 VA Primary

Addresses

Primary practice location

100 N Virginia St
Farmville, VA 23901-1537

Mailing address

12018 W Broad St
Henrico, VA 23233-7796
Phone (804) 287-4200

Other identifiers 2

IdentifierTypeStateIssuer
242205OtherVAANTHEM
009235060MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20040728001632 VA Practitioner - Optometry 8921078783 Reassigns benefits to 1 organization
Practice locations: Farmville, VA

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Surgeons of Richmond IncGroup PAC ID 5799778320, 44 clinicians

Practice addresses (Care Compare)

11601 Iron Bridge Rd
Suite 200
Chester, VA 23831-1468
Phone (804) 340-5730

12018 W Broad St
Suite 100
Henrico, VA 23233-7796
Phone (804) 287-1380

Merit-based Incentive Payment System (MIPS)

Final score
91.89 of 100Reported as group
Quality
90.46
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Surgeons of Richmond, Inc. CurrentSince Mar 1, 2025 Accepting new patients
Eye Surgeons of Richmond, Inc. Optometrist CurrentSince Mar 1, 2025 Accepting new patients
Daniel Kingsley O.D., P.C. Optometrist CurrentSince Oct 15, 2020 Accepting new patients
Eye Surgeons of Richmond, Inc. Optometrist Current Accepting new patients

Locations

11601 Iron Bridge Rd
Ste 200
Chester, VA 23831
Phone (804) 340-5730

100 N Virginia St
Farmville, VA 23901
Phone (434) 392-8113

8120 Pleasant Grove Rd
Mechanicsville, VA 23116
Phone (804) 915-1440

2015 Waterside Rd
Prince George, VA 23875
Phone (804) 733-7300

400 Westhampton Sta
Richmond, VA 23226

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/AICDBD

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1742256000000",
    "number": "1417063744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12018 W BROAD ST",
            "city": "HENRICO",
            "state": "VA",
            "postal_code": "232337796",
            "telephone_number": "804-287-4200",
            "fax_number": "804-364-3379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N VIRGINIA ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239011537",
            "telephone_number": "434-392-8113",
            "fax_number": "434-392-5934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGSLEY",
        "first_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-21",
        "last_updated": "2025-03-18",
        "certification_date": "2025-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618000544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "242205",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009235060",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmville, VA

Sources for this page

Verify at the official NPI Registry.