NPIMap

Organization Active NPI

Patrick J Kiella OD

  • Optometrist
  • Traverse City, MI
National Provider Identifier
1710156534
Registry record updated Apr 20, 2008
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Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4901002752 Issued in MI
Legal business name
PATRICK J KIELLA OD
Practice address
522 S Garfield Ave
Traverse City, MI 49686-3452
Phone
(231) 947-9500
NPI assigned
Feb 26, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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

Authorized official

Name
Dr. Patrick J Kiella, OD
Title
Optometrist
Phone
(231) 947-9500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4901002752 MI Primary

Addresses

Primary practice location

522 S Garfield Ave
Traverse City, MI 49686-3452

Mailing address

PO Box 687
Traverse City, MI 49685-0687
Phone (231) 947-9500

Other identifiers 1

IdentifierTypeStateIssuer
900B86507OtherMIBLUE CROSS OF MI

National Provider Directory

National Provider Directory

Locations

522 S Garfield Ave
Traverse City, MI 49686
Phone (231) 947-9500

NPI Registry JSON

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

{
    "created_epoch": "1203984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1710156534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 687",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496850687",
            "telephone_number": "231-947-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 S GARFIELD AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863452",
            "telephone_number": "231-947-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PATRICK J KIELLA OD",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-26",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KIELLA",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "231-947-9500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901002752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MI",
            "identifier": "900B86507",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.