NPIMap

Organization Active NPI

Kent M Archibald P.a.

  • Optometrist
  • Rexburg, ID
National Provider Identifier
1447579123
Registry record updated Jun 20, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPD-513 Issued in ID
Legal business name
KENT M ARCHIBALD P.A.
Practice address
76 Professional PLZ
Rexburg, ID 83440-2047
Phone
(208) 356-4585
Fax
(208) 356-4587
NPI assigned
May 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2018

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

Authorized official

Name
Dr. Kent M Archibald, O.D.NPI 1851336721
Title
President
Phone
(208) 356-4585

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OPD-513 ID Primary

Addresses

Primary practice location

76 Professional PLZ
Rexburg, ID 83440-2047

Mailing address

PO Box 430
Rexburg, ID 83440-0430
Phone (208) 356-4585

Other identifiers 5

IdentifierTypeStateIssuer
ODP-513OtherIDIDAHO OPTOMETRY LICENSE
V109-4OtherIDBLUE CROSS
00010015323OtherIDBLUE SHIELD
002457600MedicaidID
410007525OtherIDRAIL ROAD

National Provider Directory

National Provider Directory

Locations

76 Professional Plz
Rexburg, ID 83440
Phone (208) 356-4585

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1274313600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529452800000",
    "number": "1447579123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 430",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834400430",
            "telephone_number": "208-356-4585",
            "fax_number": "208-356-4587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "76 PROFESSIONAL PLZ",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834402047",
            "telephone_number": "208-356-4585",
            "fax_number": "208-356-4587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT M ARCHIBALD P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-20",
        "last_updated": "2018-06-20",
        "status": "A",
        "authorized_official_last_name": "ARCHIBALD",
        "authorized_official_first_name": "KENT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-356-4585",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "ID",
            "license": "OPD-513",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IDAHO OPTOMETRY LICENSE",
            "identifier": "ODP-513",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "V109-4",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "00010015323",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002457600",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD",
            "identifier": "410007525",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rexburg, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.