Active NPI
Brandon John Kellum, DISPENSING OPTICIAN
- Optician
- Soldotna, AK
National Provider Identifier
1689411340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 202907
- Practice address
- 230 E Marydale Ave
Soldotna, AK 99669-7648 - Phone
- (907) 262-3119
- Fax
- (907) 262-9290
- NPI assigned
- Jul 10, 2024
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 202907 | AK | Primary |
Addresses
Primary practice location
230 E Marydale Ave
Soldotna, AK 99669-7648
Mailing address
1806 Miranda CT
Kenai, AK 99611-6658
Phone (907) 320-0663
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 202907 | AK | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1720569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720569600000",
"number": "1689411340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1806 MIRANDA CT",
"city": "KENAI",
"state": "AK",
"postal_code": "996116658",
"telephone_number": "907-320-0663"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "230 E MARYDALE AVE",
"city": "SOLDOTNA",
"state": "AK",
"postal_code": "996697648",
"telephone_number": "907-262-3119",
"fax_number": "907-262-9290"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KELLUM",
"first_name": "BRANDON",
"middle_name": "JOHN",
"credential": "DISPENSING OPTICIAN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-07-10",
"last_updated": "2024-07-10",
"certification_date": "2024-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "AK",
"license": "202907",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Soldotna, AK
- Michelle Kearby, OTR/L
- Kristen Keeley, MD
- Keen Eye Care Assisted Living Inc
- Kristen Nicole Keeton, OTR/L
- William Joseph Kelley, MD
- Kirsten Kempf, SLPA
- Kenai Peninsula Anesthesia, LLC
- Kenai Peninsula Borough
- Kenai Peninsula Borough School District
- Kenai Peninsula Health System LLC Urgent Care of Soldotna
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.