Active NPI
Kenny J Wyatt, OD
- Corneal and Contact Management Optometrist
- Mountain View, AR
National Provider Identifier
1427056951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Corneal and Contact Management Optometrist
- License
- 2209
- Practice address
- 202 Peabody
Mountain View, AR 72560 - Phone
- (870) 269-3610
- Fax
- (870) 269-5086
- NPI assigned
- Jul 8, 2005
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Corneal and Contact Management Optometrist | 152WC0802X | 2209 | AR | Primary |
Addresses
Primary practice location
202 Peabody
Mountain View, AR 72560
Mailing address
PO Box 1460
Mountain View, AR 72560-1460
Phone (870) 269-3610
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 16064000040 | Other | AR | QUALCHOICE ID # |
| 106031722 | Medicaid | AR | |
| P00135331 | Other | AR | MEDICARE RR ID # |
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 |
|---|---|---|---|
| 2209 | AR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1120780800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271808000000",
"number": "1427056951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1460",
"city": "MOUNTAIN VIEW",
"state": "AR",
"postal_code": "725601460",
"telephone_number": "870-269-3610",
"fax_number": "870-269-5086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "202 PEABODY",
"city": "MOUNTAIN VIEW",
"state": "AR",
"postal_code": "72560",
"telephone_number": "870-269-3610",
"fax_number": "870-269-5086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "KENNY",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-07-08",
"last_updated": "2010-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "152WC0802X",
"taxonomy_group": "",
"desc": "Optometrist, Corneal and Contact Management",
"state": "AR",
"license": "2209",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "QUALCHOICE ID #",
"identifier": "16064000040",
"state": "AR"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "106031722",
"state": "AR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RR ID #",
"identifier": "P00135331",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mountain View, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.