Jeffrey James Kenyon, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004316 Issued in MI

Practice address

2112 East Paris Ave SE
Grand Rapids, MI 49546-8294

Phone

(616) 949-8500

Fax

(616) 949-2878

NPI assigned

Apr 10, 2006

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

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

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

Ferris State College - College of Optometry, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

West Michigan Eyecare Associates LLCGroup PAC ID 2567567746, 5 clinicians

Thornapple EyecareGroup PAC ID 5991156085, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Thornapple Eyecare

  • Optometrist
  • Middleville, MI
  • NPI 1205617776
  Medicare reassignment Care Compare group NPD Authorized official
• West Michigan Eyecare Associates LLC

  • Optometrist
  • Grand Rapids, MI
  • NPI 1487691366
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1481673600000",
    "number": "1659334522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2112 EAST PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-949-8500",
            "fax_number": "616-949-2878"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2112 EAST PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-949-8500",
            "fax_number": "616-949-2878"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENYON",
        "first_name": "JEFFREY",
        "middle_name": "JAMES",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-10",
        "last_updated": "2016-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4879094",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "JK004316",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kentwood Pharmacy LLC
• Chris L Kenward, MSW
• Carol Kenworthy
• Abigail Anne Kenyon
• Breeanne Kenyon, PA-C
• Laura Lynn Kenyon, O.D.
• Alyssa Keown
• Sara Moore Kerai, LPC
• Kendra Leigh Kerbs, OTR/L
• James Thomas Kerby, MD

• Optometrist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2016; 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.