Active NPI
Kevin T Jennings, OD
- Optometrist
- Burlington, IA
National Provider Identifier
1801874714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- IA1897
- Practice address
- 2743 Mt Pleasant St
Burlington, IA 52601-2137 - Phone
- (319) 754-2020
- Fax
- (319) 754-2299
- NPI assigned
- Jan 3, 2006
- Last updated
- Apr 3, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | IA1897 | IA | Primary |
Addresses
Primary practice location
2743 Mt Pleasant St
Burlington, IA 52601-2137
Mailing address
2743 Mt Pleasant St
Burlington, IA 52601-2137
Phone (319) 754-2020
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1058602 | Medicaid | IA | |
| 410012433 | Other | IA | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IA1897 | IA | MD | Optometrist |
Organizations & group practices 4
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.
-
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- NPI 1447349279
-
- Optometrist
- Fort Madison, IA
- NPI 1538258363
-
- Optometrist
- Fairfield, IA
- NPI 1720341415
-
- Optometrist
- Burlington, IA
- NPI 1881789667
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1136246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1333411200000",
"number": "1801874714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2743 MT PLEASANT ST",
"city": "BURLINGTON",
"state": "IA",
"postal_code": "526012137",
"telephone_number": "319-754-2020",
"fax_number": "319-754-2299"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2743 MT PLEASANT ST",
"city": "BURLINGTON",
"state": "IA",
"postal_code": "526012137",
"telephone_number": "319-754-2020",
"fax_number": "319-754-2299"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JENNINGS",
"first_name": "KEVIN",
"middle_name": "T",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-03",
"last_updated": "2012-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "IA1897",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1058602",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "410012433",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Burlington, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.