Kenny R Blackston OD PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

S-950-TA-529 Issued in AL

Legal business name

KENNY R BLACKSTON OD PC

Practice address

1306 River Falls St
Andalusia, AL 36421-2081

Phone

(334) 222-6325

NPI assigned

Feb 12, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Stephanie Blackston

Title

Office Manager

Phone

(334) 222-6325

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Blackston Quality Eye Care Other name

Medicare fee-for-service enrollment

Enrolled in AL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenny Ray Blackston, O.D.

  • Optometrist
  • Opp, AL
  • NPI 1740286301
  Medicare reassignment NPD
• Allan Jeffrey Kelley, MD

  • Ophthalmology Physician
  • Dothan, AL
  • NPI 1487695458
  NPD (past)

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1710028618",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 638",
            "city": "ANDALUSIA",
            "state": "AL",
            "postal_code": "364201212",
            "telephone_number": "334-222-6325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 RIVER FALLS ST",
            "city": "ANDALUSIA",
            "state": "AL",
            "postal_code": "364212081",
            "telephone_number": "334-222-6325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNY R BLACKSTON OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "BLACKSTON",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "334-222-6325",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-950-TA-529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0515-19208",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009943415",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackston Quality Eye Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Dana Jones, AANP-FNP
• Sonja Jones
• Lauren Hunter Karl, BCBA, LBA
• Meron Kassaye, PHARMD
• Micalyn Kelley, APRN
• Charles Reid Kerr, M.D.
• Melissa Killough, LPC
• Kindred Harmony Counseling, LLC
• Robert Parrish King, D.M.D.
• William G King Jr., DMD

• Optometrist in Andalusia, AL
• Providers in Andalusia, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.