Active NPI
Kenneth L Burke, OD
- Optometrist
- Woodbury, CT
National Provider Identifier
1881608263
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 000817
- Practice address
- 175 Main St S
Woodbury, CT 06798-3405 - Phone
- (203) 263-3391
- Fax
- (203) 263-3390
- NPI assigned
- Jul 28, 2006
- 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 | 000817 | CT | Primary |
Addresses
Primary practice location
175 Main St S
Woodbury, CT 06798-3405
Mailing address
PO Box 384
Woodbury, CT 06798-0384
Phone (203) 263-3391
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 83587 | Other | CT | AETNA |
| 090000817CT01 | Other | CT | ANTHEM |
| 3582 | Other | CT | DAVIS VISION |
| P382850 | Other | CT | OXFORD |
| 009287 | Other | CT | BLOCK |
| 658049 | Other | CT | CONNECTICARE |
| 0V0992 | Other | CT | HEALTHNET |
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 |
|---|---|---|---|
| 000817 | CT | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tribury Eye Care | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Optometrist
- Woodbury, CT
- NPI 1457010688
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154044800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206489600000",
"number": "1881608263",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 384",
"city": "WOODBURY",
"state": "CT",
"postal_code": "067980384",
"telephone_number": "203-263-3391",
"fax_number": "203-263-3390"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "175 MAIN ST S",
"city": "WOODBURY",
"state": "CT",
"postal_code": "067983405",
"telephone_number": "203-263-3391",
"fax_number": "203-263-3390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURKE",
"first_name": "KENNETH",
"middle_name": "L",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-28",
"last_updated": "2008-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CT",
"license": "000817",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "83587",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "090000817CT01",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DAVIS VISION",
"identifier": "3582",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OXFORD",
"identifier": "P382850",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLOCK",
"identifier": "009287",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CONNECTICARE",
"identifier": "658049",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHNET",
"identifier": "0V0992",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Woodbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.