Kenneth D Boltz OD LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

3782 Issued in OH

Legal business name

KENNETH D BOLTZ OD LLC

Practice address

5775 Perimeter Dr
Suite 160
Dublin, OH 43017-3238

Phone

(614) 763-5775

Fax

(614) 675-3338

NPI assigned

Jun 16, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth D Bolts, OD

Title

President

Phone

(614) 284-0794

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kenneth David Boltz, O.D.

  • Optometrist
  • Dublin, OH
  • NPI 1699767632
  Medicare reassignment NPD

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

{
    "created_epoch": "1466035200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466035200000",
    "number": "1992155204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5775 PERIMETER DR",
            "address_2": "SUITE 160",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430173238",
            "telephone_number": "614-763-5775",
            "fax_number": "614-675-3338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5775 PERIMETER DR",
            "address_2": "SUITE 160",
            "city": "DUBLIN",
            "state": "OH",
            "postal_code": "430173238",
            "telephone_number": "614-763-5775",
            "fax_number": "614-675-3338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH D BOLTZ OD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-16",
        "last_updated": "2016-06-16",
        "status": "A",
        "authorized_official_last_name": "BOLTS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "614-284-0794",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• April Colleen Kenison, CDCA
• Cheryl Kennedy-Carr
• Kelly Kennedy
• Sherly Ann Kennedy, M.A.
• Zachary Kennedy
• Manisha Kenney
• Kaleb Kenworthy
• Gabriele Kepling, RBT
• Megan Keppler, PMHNP-BC
• Lisa Kermode

• Optometrist in Dublin, OH
• Providers in Dublin, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.