Kyle Shively, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

14037TLG Issued in CA

Practice address

5603 Auburn St Unit a
Bakersfield, CA 93306-2979

Phone

(661) 489-7765

Fax

(209) 722-1118

NPI assigned

Aug 18, 2010

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 CA

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 California - School of Optometry, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bespectacled Eye Care Optometric CorpGroup PAC ID 4880986843, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Bespectacled Eye Care Optometric Corp

  • Optometrist
  • Bakersfield, CA
  • NPI 1215387469
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1282089600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539820800000",
    "number": "1861707564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5603 AUBURN ST UNIT A",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933062979",
            "telephone_number": "661-489-7765",
            "fax_number": "661-246-3566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5603 AUBURN ST UNIT A",
            "city": "BAKERSFIELD",
            "state": "CA",
            "postal_code": "933062979",
            "telephone_number": "661-489-7765",
            "fax_number": "209-722-1118"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7508 Meany Ave",
            "address_purpose": "LOCATION",
            "city": "Bakersfield",
            "state": "CA",
            "postal_code": "933085178",
            "country_code": "US",
            "telephone_number": "661-589-9400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHIVELY",
        "first_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-18",
        "last_updated": "2018-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "14037TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maryellen A Shimmel, RN, MFT
• Ben Shimogaki, O.D.
• Vanessa Anne Shin
• Shyi-Tang Shiue, M.D.
• David Dean Shively, DDS
• Jazmyne Shiver
• Shivinder S Deol M D Inc
• Shivom Corporation
• Perri Shoemaker, MS
• Justis Hope Shook

• Optometrist in Bakersfield, CA
• Providers in Bakersfield, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2018; 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.