Kyle J Kenison, O.D.

Key facts

NPI

1750370730

Entity type

Individual (NPI type 1)

Primary specialty

Optometrist 152W00000X

License

MT 587 (MT)

Practice address

855 West 6TH South
Mountain Home, ID 83647

Phone

(208) 587-2020

Fax

(208) 587-3349

NPI assigned

Oct 21, 2005

Sex

Male

Sole proprietor

No

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.

• Elmore County Eyecare, PA. Optometrist · Mountain Home, ID · NPI 1003973736
  Medicare reassignment Care Compare group NPD ID · OPTOMETRIST

Medicare Care Compare profile

Specialty

Optometry

Education

Pacific University - College of Optometry, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Elmore County Eyecare, PA. (3 clinicians)

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare participation

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Medicare enrollment records

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Practice roles

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 15, 2017.

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1489536000000",
    "number": "1750370730",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 WEST 6TH SOUTH",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "83647",
            "telephone_number": "208-587-2020",
            "fax_number": "208-587-3349"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "855 WEST 6TH SOUTH",
            "city": "MOUNTAIN HOME",
            "state": "ID",
            "postal_code": "83647",
            "telephone_number": "208-587-2020",
            "fax_number": "208-587-3349"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENISON",
        "first_name": "KYLE",
        "middle_name": "J",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-21",
        "last_updated": "2017-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MT",
            "license": "MT 587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1750370730",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Mountain Home, ID · Optometrist in Idaho