Richard Charles Kern, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

0467198 Issued in IL

Practice address

4408 N Knoxville Ave
Suite C
Peoria, IL 61614-6084

Phone

(309) 682-6214

Fax

(309) 682-6236

NPI assigned

Jan 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210896000000",
    "number": "1497812242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4408 N KNOXVILLE AVE",
            "address_2": "SUITE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146084",
            "telephone_number": "309-682-6214",
            "fax_number": "309-682-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4408 N KNOXVILLE AVE",
            "address_2": "SUITE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616146084",
            "telephone_number": "309-682-6214",
            "fax_number": "309-682-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERN",
        "first_name": "RICHARD",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-02",
        "last_updated": "2008-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "0467198",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007198",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Bradley Kentosh, D.O.
• Danielle Marie Keowen, OTR
• Cara Nicole Keplar, LCSW
• Kern Optometric Associates PC
• Dustin Kern
• Troy Kern
• Nicole Kerner, APRN
• Ghaly Kerolus, MD
• Richard Todd Kerr, PA-C, ATC
• Faye Kesselmayer, MSW LCSW

• Optometrist in Peoria, IL
• Providers in Peoria, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2008; 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.