Kenneth Francis Van, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

33905TLG Issued in CA

Practice address

5729 Nutwood Cir
Simi Valley, CA 93063-3566

Phone

(805) 587-3693

NPI assigned

Apr 13, 2018

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Western University of Health Sciences College of Dental Med, 2017

Medicare assignment

May accept Medicare assignment

Group practices

Fourth Optometric Care of CaliforniaGroup PAC ID 6305210345, 25 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.

• Fourth Optometric Care of California

  • Optometrist
  • Mountain View, CA
  • NPI 1497499974
  Medicare reassignment Care Compare group NPD
• Fourth Optometric Care of California

  • Optometrist
  • Orange, CA
  • NPI 1417627944
  NPD
• Fourth Optometric Care of California

  • Optometrist
  • Mountain View, CA
  • NPI 1689248874
  NPD
• Fourth Optometric Care of California

  • Optometrist
  • Woodland Hills, CA
  • NPI 1568198281
  NPD (past)

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

{
    "created_epoch": "1523577600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523577600000",
    "number": "1982191110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5729 NUTWOOD CIR",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930633566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5729 NUTWOOD CIR",
            "city": "SIMI VALLEY",
            "state": "CA",
            "postal_code": "930633566",
            "telephone_number": "805-587-3693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "KENNETH",
        "middle_name": "FRANCIS",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-04-13",
        "last_updated": "2018-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "33905TLG",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valley Hospice Services LLC
• Valley Pacific Hospice, Inc.
• Stephen Philip Vampola, MD
• Judy Van Der Wende, PH.D.
• Deborah Van, DDS
• Kevin Van
• Patricia Lynn Vanbuskirk, MA, MFT
• Ann Taylor Vance, PH.D.
• Brooke Celia Vanover, LCSW
• Vantage Toxicology Management

• Optometrist in Simi Valley, CA
• Providers in Simi Valley, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2018; 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.