Active NPI
Kelly Jo Robertson, OD
- Optometrist
- Omaha, NE
National Provider Identifier
1942368246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1256
- Practice address
- 3001 S 144TH Street
Suite 2001
Omaha, NE 68144 - Phone
- (402) 697-7093
- Fax
- (402) 697-7049
- NPI assigned
- Dec 5, 2006
- Last updated
- Jul 15, 2014
- Sex
- Female
- 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 | 1256 | NE | Primary |
Addresses
Primary practice location
3001 S 144TH Street
Suite 2001
Omaha, NE 68144
Mailing address
3001 S 144TH St
Suite 2001
Omaha, NE 68144-5221
Phone (402) 697-7093
Other names 1
- Kelly Jo Wilson
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
- Indiana University - School of Optometry, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
12744 Westport Pkwy
Suite 1E
La Vista, NE 68138-4017
Phone (402) 502-1228
12744 Westport Pkwy
Suite 1E
La Vista, NE 68138-4020
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 17 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba ProEye Vision Center Omaha
- Optometrist
- La Vista, NE
- NPI 1285843151
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405382400000",
"number": "1942368246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3001 S 144TH ST",
"address_2": "SUITE 2001",
"city": "OMAHA",
"state": "NE",
"postal_code": "681445221",
"telephone_number": "402-697-7093",
"fax_number": "402-697-7049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3001 S 144TH STREET",
"address_2": "SUITE 2001",
"city": "OMAHA",
"state": "NE",
"postal_code": "68144",
"telephone_number": "402-697-7093",
"fax_number": "402-697-7049"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "KELLY",
"middle_name": "JO",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-05",
"last_updated": "2014-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NE",
"license": "1256",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "KELLY",
"last_name": "WILSON",
"middle_name": "JO",
"code": "1",
"type": "Former Name"
}
]
}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 Jul 15, 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.