Kyle Henderson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2853 Issued in OK

Practice address

1207 Cornwell Dr
Yukon, OK 73099-4633

Phone

(405) 354-3384

Fax

(405) 354-0703

NPI assigned

Jul 21, 2015

Last updated

Nov 25, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

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

Specialty

Optometry

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kyle.henderson@uprisedirect.com

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.

• Legacy Eye Care PLLC

  • Optometrist
  • Yukon, OK
  • NPI 1225647415
  Medicare reassignment NPD Authorized official
• David C Brewer Optometrist, P C

  • Optometrist
  • Yukon, OK
  • NPI 1619096021
  NPD
• Scott C. Sigler MD PC

  • Ophthalmology Physician
  • Edmond, OK
  • NPI 1801831011
  NPD (past)

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

{
    "created_epoch": "1437436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606262400000",
    "number": "1780069609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 CORNWELL DR",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730994633",
            "telephone_number": "405-354-3384",
            "fax_number": "405-354-0703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 CORNWELL DR",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730994633",
            "telephone_number": "405-354-3384",
            "fax_number": "405-354-0703"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "501 E 15th St",
            "address_2": "Suite 101",
            "address_purpose": "LOCATION",
            "city": "Edmond",
            "state": "OK",
            "postal_code": "730135043",
            "country_code": "US",
            "telephone_number": "405-341-2062",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1455 S Douglas Blvd",
            "address_purpose": "LOCATION",
            "city": "Oklahoma City",
            "state": "OK",
            "postal_code": "731305268",
            "country_code": "US",
            "telephone_number": "405-733-4545",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENDERSON",
        "first_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-21",
        "last_updated": "2020-11-25",
        "certification_date": "2020-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caitlin Heck
• Rylee Heger, M.S., CCC-SLP
• Chester Alan Hendershot Jr., MHA,MHS, PA-C
• Jennifer Lynn Henderson
• Kalehia Henderson
• Beonica Henry, RBT
• Kathy Henry, PHARMACIST
• Nancy E. M. Henry, PT, DPT
• Jonathan Tyler Henson, PHARM D.
• Malisa Dawn Hepner, LCSW

• Optometrist in Yukon, OK
• Providers in Yukon, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.