Kenneth L. Stack Optometrist, PC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV004607-1 Issued in NY

Legal business name

KENNETH L. STACK OPTOMETRIST, PC

Practice address

24 Rosemont St
Albany, NY 12203-2405

Phone

(518) 438-6669

Fax

(518) 489-4372

NPI assigned

Jan 24, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth L. Stack, ODNPI 1093756371

Title

President

Phone

(518) 438-6669

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Locations

Practitioners 2

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

• Kenneth L. Stack, O.D.

  • Optometrist
  • Albany, NY
  • NPI 1093756371
  Medicare reassignment NPD Authorized official
• Frank Cirillo Jr.

  • Optician
  • Albany, NY
  • NPI 1144556929
  NPD (past)

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

{
    "created_epoch": "1201132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1760669485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 ROSEMONT ST",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122032405",
            "telephone_number": "518-438-6669",
            "fax_number": "518-489-4372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 ROSEMONT ST",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122032405",
            "telephone_number": "518-438-6669",
            "fax_number": "518-489-4372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH L. STACK OPTOMETRIST, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-24",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "STACK",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "518-438-6669",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV004607-1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00931291",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Kennedy, COTA
• M. Katherine Kennedy, PH.D.
• Margaret Kennedy, PA
• Shannon M Kennedy, NP
• Thomas M. Kennedy, M.D.
• Jeffrey D Kennicutt, PHARM.D.
• Sarah Elizabeth Kenning, M.S.
• Kenneth E Kent Jr., NP
• Madison Kent
• Alexander Benjamin Kenton, MD

• Optometrist in Albany, NY
• Providers in Albany, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.