Individual provider Active NPI

Kirk C. Maynard, OD

  • Optometrist
  • Omaha, NE
National Provider Identifier
1902891096
Registry record updated Apr 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1251 Issued in NE
Practice address
16016 Evans St
Suite 101
Omaha, NE 68116-6457
Phone
(402) 493-3224
Fax
(402) 493-4041
NPI assigned
Sep 14, 2005
Last updated
Apr 2, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046007646 IL
Optometrist 152W00000X 1251 NE Primary

Addresses

Primary practice location

16016 Evans St
Suite 101
Omaha, NE 68116-6457

Mailing address

16016 Evans St
Suite 101
Omaha, NE 68116-6457
Phone (402) 493-3224

Other identifiers 1

IdentifierTypeStateIssuer
47048659410MedicaidNE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE
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

Enrollment IDStateProvider typePAC IDDetails
I20080104000282 NE Practitioner - Optometry 0042390932 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois Medical College, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
International Eyecare Center LLCGroup PAC ID 0244125235, 20 clinicians

Practice addresses (Care Compare)

10114 Maple St
Omaha, NE 68134-5555
Phone (402) 571-8888

8102 S 84TH St
1068 Brentwood
La Vista, NE 68128-3305
Phone (402) 339-5550

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
046007646ILMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
International Eyecare Center LLC Optometrist CurrentSince Apr 24, 2017 Accepting new patients
International Eyecare Center, Inc. Optometrist Past Accepting new patients

Locations

211 E Broadway
Alton, IL 62002
Phone (314) 787-0681

10114 Maple St
#1070
Omaha, NE 68134
Phone (402) 391-6600

16016 Evans St
Ste 101
Omaha, NE 68116
Phone (402) 493-3224

409 N 78th St
Omaha, NE 68114
Phone (402) 391-6600

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396396800000",
    "number": "1902891096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16016 EVANS ST",
            "address_2": "SUITE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681166457",
            "telephone_number": "402-493-3224",
            "fax_number": "402-493-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16016 EVANS ST",
            "address_2": "SUITE 101",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681166457",
            "telephone_number": "402-493-3224",
            "fax_number": "402-493-4041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAYNARD",
        "first_name": "KIRK",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-14",
        "last_updated": "2014-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046007646",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "1251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47048659410",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.