Active NPI
Kirk C. Maynard, OD
- Optometrist
- Omaha, NE
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1251
- 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, 2014
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47048659410 | Medicaid | NE |
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
Enrollment records 1
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
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
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 046007646 | IL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| International Eyecare Center LLC | Optometrist | Current | 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2014; 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.