Active NPI
Kevin M Brown, O.D.
- Optometrist
- Vermillion, SD
National Provider Identifier
1619916871
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- SD152
- Practice address
- 11 Shriner St
Vermillion, SD 57069-1155 - Phone
- (605) 624-2020
- Fax
- (605) 624-7961
- NPI assigned
- Jun 5, 2006
- Last updated
- Feb 13, 2008
- Sex
- Male
- Sole proprietor
- No
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 | SD152 | SD | Primary |
Addresses
Primary practice location
11 Shriner St
Vermillion, SD 57069-1155
Mailing address
11 Shriner St
Vermillion, SD 57069-1155
Phone (605) 624-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9201660 | Medicaid | SD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SD
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061129000058 | SD | Practitioner - Optometry | 4688672694 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SD152 | SD | MD | Optometrist |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1202860800000",
"number": "1619916871",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 SHRINER ST",
"city": "VERMILLION",
"state": "SD",
"postal_code": "570691155",
"telephone_number": "605-624-2020",
"fax_number": "605-624-7961"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 SHRINER ST",
"city": "VERMILLION",
"state": "SD",
"postal_code": "570691155",
"telephone_number": "605-624-2020",
"fax_number": "605-624-7961"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROWN",
"first_name": "KEVIN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-05",
"last_updated": "2008-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "SD",
"license": "SD152",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9201660",
"state": "SD"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Vermillion, SD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.