Kevin Gregory Lockhart, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9297T Issued in CA

Practice address

5520 Douglas Blvd
Suite 110
Granite Bay, CA 95746-6288

Phone

(916) 791-5490

Fax

(916) 791-3099

NPI assigned

Dec 29, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Optometry

Education

Southern California College of Optometry, 1989

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Granite Bay Vision Center Optometry, Inc.Group PAC ID 6305205790, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Granite Bay Vision Center Optometry, Inc.

  • Optometrist
  • Granite Bay, CA
  • NPI 1477243301
  Medicare reassignment Care Compare group NPD
• Pro Dynamic Physical Therapy Inc.

  • Physical Therapist
  • Granite Bay, CA
  • NPI 1437522455
  NPD (past)

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

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366675200000",
    "number": "1962568329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5520 DOUGLAS BLVD",
            "address_2": "SUITE 110",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466288",
            "telephone_number": "916-791-5490",
            "fax_number": "916-791-3099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5520 DOUGLAS BLVD",
            "address_2": "SUITE 110",
            "city": "GRANITE BAY",
            "state": "CA",
            "postal_code": "957466288",
            "telephone_number": "916-791-5490",
            "fax_number": "916-791-3099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKHART",
        "first_name": "KEVIN",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2013-04-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "9297T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "680428633",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2230825",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life River Acupuncture and Integrative Medicine Inc.
• Brooke Lillibridge
• Shann Louis Lim
• Pieter Linssen, D.D.S.
• Samantha Little, PPS
• Longs Drug Stores California LLC
• Tehya Loren
• Allisha Kay Loveless
• Jennifer Lubin, M.S.
• Stephanie Anne Luby, RN

• Optometrist in Granite Bay, CA
• Providers in Granite Bay, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2013; 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.

Verify at the official NPI Registry.