Kenneth John Wich, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPT 793 Issued in ME

Practice address

82 Water St
Ellsworth, ME 04605-2006

Phone

(207) 667-8615

Fax

(207) 667-4212

NPI assigned

Aug 5, 2006

Last updated

Jan 18, 2012By 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

Other identifiers 4

Medicare fee-for-service enrollment

Enrolled in ME

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

University of Missouri St Louis - School of Optometry, 1992

Medicare assignment

May accept Medicare assignment

Group practices

Seebreeze Family Eyecare, P.a.Group PAC ID 0840429791, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Seebreeze Family Eyecare, P.a.

  • Optometrist
  • Belfast, ME
  • NPI 1700212966
  Medicare reassignment Care Compare group NPD
• Eyes, P.a.

  • Optometrist
  • Ellsworth, ME
  • NPI 1477564235
  Medicare reassignment NPD
• Eyes, P.a.

  • Optometrist
  • Mount Desert, ME
  • NPI 1952501231
  NPD
• DRS. Dutch & Marnecheck,LLC

  • Optometrist
  • Belfast, ME
  • NPI 1073609129
  NPD (past)

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1326844800000",
    "number": "1861401267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "82 WATER ST",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046052006",
            "telephone_number": "207-667-8615",
            "fax_number": "207-667-4212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "82 WATER ST",
            "city": "ELLSWORTH",
            "state": "ME",
            "postal_code": "046052006",
            "telephone_number": "207-667-8615",
            "fax_number": "207-667-4212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICH",
        "first_name": "KENNETH",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2012-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ME",
            "license": "OPT 793",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "004835",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS",
            "identifier": "522108187534",
            "state": "ME"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "299840099",
            "state": "ME"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410047012",
            "state": "ME"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Hannah Marie Whalen, CADC
• Mary T. White, M.ED., L.P.C.
• Sarah J White, CADC
• Diane Marie Whitney, RDH, LPDH
• Sheena E Whittaker, MD
• Travon M Wilcher
• Sheri Wilder, RDH
• Sterling Craige Williamson, MD
• Carol E Willliams, RDH
• Lori L Wilson, LCSW

• Optometrist in Ellsworth, ME
• Providers in Ellsworth, ME by specialty
• Optometrist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; 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.