NPIMap

Individual provider Active NPI

Ken Coy Roddy, O.D.

  • Optometrist
  • Oklahoma City, OK
National Provider Identifier
1508910498
Registry record updated Nov 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OK1140 Issued in OK
Practice address
1010 N Pennsylvania Ave
Ste a
Oklahoma City, OK 73107-6412
Phone
(405) 236-2020
Fax
(405) 236-2020
NPI assigned
Jan 22, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 7, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OK1140 OK Primary

Addresses

Primary practice location

1010 N Pennsylvania Ave
Ste a
Oklahoma City, OK 73107-6412

Mailing address

1010 N Pennsylvania Ave
Ste a
Oklahoma City, OK 73107-6412
Phone (405) 236-2020

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

LicenseStateTypeSpecialty
1140OKMDClinical Psychologist
OK1140OKMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Thomas Wolf and Associates PLLC Past Accepting new patients
Envision Optometrist Past Accepting new patients
Ken Roddy O.D., PLLC Optometrist Past Accepting new patients
Hanni Lynn Hagen OD Inc Optometrist Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415318400000",
    "number": "1508910498",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N PENNSYLVANIA AVE",
            "address_2": "STE A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731076412",
            "telephone_number": "405-236-2020",
            "fax_number": "405-236-2020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N PENNSYLVANIA AVE",
            "address_2": "STE A",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731076412",
            "telephone_number": "405-236-2020",
            "fax_number": "405-236-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODDY",
        "first_name": "KEN",
        "middle_name": "COY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-22",
        "last_updated": "2014-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "OK1140",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2014; 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.