Active NPI
John Shank, OD
- Optometrist
- Kodiak, AK
National Provider Identifier
1538296215
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0070
- Practice address
- 3450 E. Rezanof Dr.
Kodiak, AK 99615 - Phone
- (907) 486-5504
- NPI assigned
- Feb 28, 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 | 0070 | AK | Primary |
Addresses
Primary practice location
3450 E. Rezanof Dr.
Kodiak, AK 99615
Mailing address
PO Box 827
Kodiak, AK 99615-0827
Phone (907) 486-5504
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 |
|---|---|---|---|
| 70 | AK | MD | Registered Dietitian |
| 0070 | AK | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172620800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1187827200000",
"number": "1538296215",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 827",
"city": "KODIAK",
"state": "AK",
"postal_code": "996150827",
"telephone_number": "907-486-5504"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 E. REZANOF DR.",
"city": "KODIAK",
"state": "AK",
"postal_code": "99615",
"telephone_number": "907-486-5504"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHANK",
"first_name": "JOHN",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-28",
"last_updated": "2007-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "AK",
"license": "0070",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kodiak, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.