Active NPI
Kenton Lee McWilliams, O.D.
- Optometrist
- Warrenton, MO
National Provider Identifier
1962413591
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- T03461
- Practice address
- 500 Warren County Ctr
Warrenton, MO 63383-3023 - Phone
- (636) 456-5379
- Fax
- (636) 456-5410
- NPI assigned
- Aug 10, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 | T03461 | MO | Primary |
Addresses
Primary practice location
500 Warren County Ctr
Warrenton, MO 63383-3023
Mailing address
404 Angie Dr Apt D
Saint Peters, MO 63376-6321
Phone (314) 276-4897
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| T03461 | Other | MO | LICENSE # |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rosen Optometry Associates Inc | Optometrist | Past | Accepting new patients |
| Rosen Optometry Associates Inc | Optometrist | Past | Accepting new patients |
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 and National Provider Directory roles.
-
- Optometrist
- Saint Louis, MO
- NPI 1215903240
-
- Optometrist
- Saint Louis, MO
- NPI 1548231947
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1216598400000",
"number": "1962413591",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "404 ANGIE DR APT D",
"city": "SAINT PETERS",
"state": "MO",
"postal_code": "633766321",
"telephone_number": "314-276-4897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 WARREN COUNTY CTR",
"city": "WARRENTON",
"state": "MO",
"postal_code": "633833023",
"telephone_number": "636-456-5379",
"fax_number": "636-456-5410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCWILLIAMS",
"first_name": "KENTON",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2008-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MO",
"license": "T03461",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSE #",
"identifier": "T03461",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Warrenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.