Individual provider Active NPI

Kenneth J Keirsey, O.D.

  • Optometrist
  • Warrensburg, MO
National Provider Identifier
1689638785
Registry record updated Oct 4, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
TO3061 Issued in MO
Practice address
608 N Maguire St
Warrensburg, MO 64093-1420
Phone
(660) 747-7300
Fax
(660) 747-5322
NPI assigned
Apr 14, 2006
Last updated
Oct 4, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X TO3061 MO Primary

Addresses

Primary practice location

608 N Maguire St
Warrensburg, MO 64093-1420

Mailing address

608 N Maguire St
Warrensburg, MO 64093-1420
Phone (660) 747-7300

Other identifiers 4

IdentifierTypeStateIssuer
04580012OtherBLUE CROSS BLUE SHIELD KC 8 DIGIT BILLING NUBER
18576011OtherBLUE CROSS BLUE SHIELD KC
313476715MedicaidMO
18576011MedicaidMO

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Direct@InsightEyecare1WarrensburgMO.CompulinkDirect.com
Direct Messaging Address Direct@InsightEyecare1WarrensburgMO.CompulinkDirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
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
I20100601000816 MO Practitioner - Optometry 5294864203 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TO3061MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Warrensburg Optical Inc Optometrist CurrentSince Aug 22, 1995 Accepting new patients
Warrensburg Optical Inc Optometrist CurrentSince Aug 22, 1995 Accepting new patients

Locations

217 S College St
Richmond, MO 64085
Phone (660) 747-7300

602 N Maguire St
Warrensburg, MO 64093
Phone (660) 747-7300

608 N Maguire St
Warrensburg, MO 64093
Phone (660) 747-7300

Organizations & group practices 2

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": "1144972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664841600000",
    "number": "1689638785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 N MAGUIRE ST",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640931420",
            "telephone_number": "660-747-7300",
            "fax_number": "660-747-5322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 N MAGUIRE ST",
            "city": "WARRENSBURG",
            "state": "MO",
            "postal_code": "640931420",
            "telephone_number": "660-747-7300",
            "fax_number": "660-747-5322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEIRSEY",
        "first_name": "KENNETH",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-14",
        "last_updated": "2022-10-04",
        "certification_date": "2022-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "TO3061",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD KC 8 DIGIT BILLING NUBER",
            "identifier": "04580012",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD KC",
            "identifier": "18576011",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "313476715",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18576011",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@InsightEyecare1WarrensburgMO.CompulinkDirect.com",
            "affiliation": "N",
            "address_1": "608 N Maguire St",
            "city": "Warrensburg",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640931420",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Direct@InsightEyecare1WarrensburgMO.CompulinkDirect.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "608 N Maguire St",
            "city": "Warrensburg",
            "state": "MO",
            "country_code": "US",
            "postal_code": "640931420",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Warrensburg, MO

Sources for this page

Verify at the official NPI Registry.