Kurt S Petry, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002244B Issued in IN

Practice address

357C W Morgan St
Spencer, IN 47460-1219

Phone

(812) 829-2972

Fax

(812) 829-3639

NPI assigned

Nov 20, 2006

Last updated

Jan 14, 2010By the provider in NPPES

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 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kurt S. Petry OD, PC

  dba Spencer Community Eyecare

  • Optometrist
  • Spencer, IN
  • NPI 1144487638
  Authorized official Same address or phone
• Eyecare Indiana II, P.C.

  dba C&B Optical One

  • Optometrist
  • Indianapolis, IN
  • NPI 1407134950
  NPD (past)

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1263427200000",
    "number": "1578637658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357C W MORGAN ST",
            "city": "SPENCER",
            "state": "IN",
            "postal_code": "474601219",
            "telephone_number": "812-829-2972",
            "fax_number": "812-829-3639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357C W MORGAN ST",
            "city": "SPENCER",
            "state": "IN",
            "postal_code": "474601219",
            "telephone_number": "812-829-2972",
            "fax_number": "812-829-3639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRY",
        "first_name": "KURT",
        "middle_name": "S",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2010-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002244B",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARMONY HEALTH",
            "identifier": "N283918",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000087919",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL",
            "identifier": "351787030",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARESOURCE",
            "identifier": "351787030101",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100193710 C",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA/RAILROAD MEDICARE",
            "identifier": "410022263",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Owen County Emergency Medical Services
• Owen County Family Young Men's Christian Association
• Owen County Health Department
• Margaret Eden Butler Pejeau, NP
• Carol Petry, NP
• Ashley Nicole Powell
• Proactive Mso, LLC (Spencer Health Center)
• Putnam County Hospital (Owen Valley Health Campus)
• RCG Bloomington, LLC (Fresenius Medical Care Spencer)
• Cindy Rhodenbaugh, LCSW

• Optometrist in Spencer, IN
• Providers in Spencer, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2010; 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.