Individual provider Active NPI

Charles Eddie Kesner II, OD

  • Optometrist
  • Chandler, AZ
National Provider Identifier
1679655716
Registry record updated Dec 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1319 Issued in AZ
Practice address
3900 W Ray Rd
Sutie #1
Chandler, AZ 85226
Phone
(480) 820-9880
Fax
(480) 820-0232
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1319 AZ Primary

Addresses

Primary practice location

3900 W Ray Rd
Sutie #1
Chandler, AZ 85226

Mailing address

307 E Southern Ave
Tempe, AZ 85282
Phone (480) 967-5710

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AZ
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

Enrollment IDStateProvider typePAC IDDetails
I20040325001063 AZ Practitioner - Optometry 4183516172 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
John H McDougall OD Arizona PCGroup PAC ID 3274880117, 44 clinicians

Practice addresses (Care Compare)

307 E Southern Ave
Tempe, AZ 85282-5201
Phone (480) 967-4801

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1319AZMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
John H McDougall OD Arizona PC Optometrist CurrentSince Aug 1, 2018 Accepting new patients

Locations

3900 W Ray Rd
Ste 1
Chandler, AZ 85226
Phone (480) 820-9880

13125 N La Montana Dr
Ste 1
Fountain Hls, AZ 85268
Phone (480) 816-0102

3592 S Atherton Blvd
Ste 111
Gilbert, AZ 85297
Phone (480) 580-6671

9336 E Raintree Dr
Ste 140
Scottsdale, AZ 85260
Phone (480) 614-0055

307 E Southern Ave
Tempe, AZ 85282
Phone (480) 967-4801

6615 N Oracle Rd
Tucson, AZ 85704
Phone (520) 797-8000

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196726400000",
    "number": "1679655716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 E SOUTHERN AVE",
            "city": "TEMPE",
            "state": "AZ",
            "postal_code": "85282",
            "telephone_number": "480-967-5710",
            "fax_number": "480-967-2845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3900 W RAY RD",
            "address_2": "SUTIE #1",
            "city": "CHANDLER",
            "state": "AZ",
            "postal_code": "85226",
            "telephone_number": "480-820-9880",
            "fax_number": "480-820-0232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KESNER",
        "first_name": "CHARLES",
        "middle_name": "EDDIE",
        "name_suffix": "II",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1319",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chandler, AZ

Sources for this page

Verify at the official NPI Registry.