Kern Optometric Associates PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

046007198 Issued in IL

Legal business name

KERN OPTOMETRIC ASSOCIATES PC

Practice address

4408 N Knoxville Ave
Suite C
Peoria, IL 61614

Phone

(309) 682-6214

Fax

(309) 682-6236

NPI assigned

Dec 4, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard C Kern, OD

Title

Optometrist

Phone

(309) 682-6244

Specialties & licenses 2

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1196726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1367884800000",
    "number": "1598947343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4408 N KNOXVILLE AVE",
            "address_2": "SUITE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-682-6214",
            "fax_number": "309-682-6236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4408 N KNOXVILLE AVE",
            "address_2": "SUITE C",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "61614",
            "telephone_number": "309-682-6214",
            "fax_number": "309-682-6236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KERN OPTOMETRIC ASSOCIATES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-04",
        "last_updated": "2013-05-07",
        "status": "A",
        "authorized_official_last_name": "KERN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "309-682-6244",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007198",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "0467198",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "046007198",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI INDIVIDUAL CROSSOVER",
            "identifier": "1497812242",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth D. Meiss D.M.D. LTD.
• James Nicholas Kenny Jr., M.D.
• Joshua Bradley Kentosh, D.O.
• Danielle Marie Keowen, OTR
• Cara Nicole Keplar, LCSW
• Dustin Kern
• Richard Charles Kern, O.D.
• Troy Kern
• Nicole Kerner, APRN
• Ghaly Kerolus, MD

• Optometrist in Peoria, IL
• Providers in Peoria, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2013; 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.