Individual provider Active NPI

John T Koehler, O.D.

  • Optometrist
  • Fort Meade, MD
National Provider Identifier
1568877926
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG002962 Issued in PA
Practice address
2480 Llewellyn Ave
Fort Meade, MD 20755-7081
Phone
(301) 677-8800
NPI assigned
Jun 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG002962 PA Primary

Addresses

Primary practice location

2480 Llewellyn Ave
Fort Meade, MD 20755-7081

Mailing address

2480 Llewellyn Ave
Fort Meade, MD 20755-7081
Phone (301) 677-8800

Other practice location 1

1 Jarrett White Rd
Tripler Army Medical Center, HI 96859-5001
Phone (808) 433-6661

Other practice location 2

BLDG 683 Waianae Ave
Schofield Barracks, HI 96786
Phone (808) 433-8500

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)
Not enrolled

State licenses

LicenseStateTypeSpecialty
OEG002962PAMDOptometrist

NPI Registry JSON

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1568877926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207557081",
            "telephone_number": "301-677-8800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2480 LLEWELLYN AVE",
            "city": "FORT MEADE",
            "state": "MD",
            "postal_code": "207557081",
            "telephone_number": "301-677-8800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Jarrett White Rd",
            "address_purpose": "LOCATION",
            "city": "Tripler Army Medical Center",
            "state": "HI",
            "postal_code": "968595001",
            "country_code": "US",
            "telephone_number": "808-433-6661",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "BLDG 683 WAIANAE AVE",
            "address_purpose": "LOCATION",
            "city": "SCHOFIELD BARRACKS",
            "state": "HI",
            "postal_code": "96786",
            "country_code": "US",
            "telephone_number": "808-433-8500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOEHLER",
        "first_name": "JOHN",
        "middle_name": "T",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG002962",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Meade, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; 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.