Kendall Craig Willden, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV007801 Issued in NY

Practice address

2990 S 25TH E
Idaho Falls, ID 83404-6515

Phone

(833) 776-2020

NPI assigned

Sep 4, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Idaho Eye Pros Idaho Falls LLCGroup PAC ID 6507184744, 3 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

92.14 of 100Reported as group

Quality

84.28

Improvement activities

40

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kendall.willden@direct.revolutionehr.com

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.

• Idaho Eye Pros Idaho Falls LLC

  • Optometrist
  • Idaho Falls, ID
  • NPI 1528494465
  Medicare reassignment Care Compare group NPD
• LWK, P.C.

  • Optometrist
  • Boise, ID
  • NPI 1851624019
  Medicare reassignment NPD

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

{
    "created_epoch": "1283558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672876800000",
    "number": "1598072043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 N COLE RD UNIT 45479",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837111095",
            "telephone_number": "208-954-9106"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2990 S 25TH E",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046515",
            "telephone_number": "833-776-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLDEN",
        "first_name": "KENDALL",
        "middle_name": "CRAIG",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-04",
        "last_updated": "2023-01-05",
        "certification_date": "2022-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV007801",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Johnathon Chase Wilde, PA-C
• Joshua Barnett Wilde
• Shannon Wilkins
• Jed Burke Willardson, PA
• Shellie Willardson
• Jesse Wille
• William Wilson MD PC
• Whitney Williams Dutton, LPC
• Williams Hearing, Inc.
• James T Williams

• Optometrist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.