Active NPI
Charles Stephen Koon, OD
- Optometrist
- Piqua, OH
National Provider Identifier
1437290590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2849 T523
- Practice address
- 615 N Wayne St
Piqua, OH 45356-2015 - Phone
- (937) 773-8905
- Fax
- (937) 778-8465
- NPI assigned
- Feb 10, 2007
- 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 | 2849 T523 | OH | Primary |
Addresses
Primary practice location
615 N Wayne St
Piqua, OH 45356-2015
Mailing address
615 N Wayne St
Piqua, OH 45356-2015
Phone (937) 773-8905
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OH
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120330000539 | OH | Practitioner - Optometry | 3678688165 | Practice locations: Piqua, OH |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2849 | OH | MD | Chiropractor |
| 2849 T523 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1228435200000",
"number": "1437290590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 N WAYNE ST",
"city": "PIQUA",
"state": "OH",
"postal_code": "453562015",
"telephone_number": "937-773-8905",
"fax_number": "937-778-8465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 N WAYNE ST",
"city": "PIQUA",
"state": "OH",
"postal_code": "453562015",
"telephone_number": "937-773-8905",
"fax_number": "937-778-8465"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOON",
"first_name": "CHARLES",
"middle_name": "STEPHEN",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-10",
"last_updated": "2008-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "2849 T523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Piqua, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.