DR. KERRY K CHILDERS (NPI# 1114906310) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114906310 |
| Entity Type | Individual |
| Full Name | DR. KERRY K CHILDERS |
| Credential | O.D. |
| Practice Address |
723 Falls Blvd S Ste A Wynne AR 72396-3508 |
| Practice Telephone | 8702382020 |
| Practice Fax Number | 8702384320 |
| Mailing Telephone | 8702382020 |
| Mailing Fax Number | 8702384320 |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2015-03-17 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
2038 | AR | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | PTAN | 64772430001 | 01 |
| AR | 102042722 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952524639 | Kerry Lee Childers | Counselor | 604 Pearl St, Monterey, CA 93940-3070 | 2007-04-11 |
| Street Address |
723 FALLS BLVD S STE A |
| City | WYNNE |
| State | AR |
| Zip Code | 72396-3508 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407238736 | Austin Swain | Optometrist | 723 Falls Blvd S, Suite A, Wynne, AR 72396-3508 | 2015-06-23 |
| 1003125535 | Childers and Jackson Family Eye Care Inc. | Optometrist | 723 Falls Blvd S, Ste A, Wynne, AR 72396-3508 | 2010-10-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962918813 | David Makool | Occupational Therapy Assistant | 2000 Gogbill Road, Wynne, AR 72396 | 2017-12-14 |
| 1912425554 | Barbara Ann Burgess | Case Manager/Care Coordinator | 661 Addison, Wynne, AR 72396 | 2017-09-05 |
| 1518481308 | Tyler Leigh Shumard | Physical Therapy Assistant | 128 County Road 145, Wynne, AR 72396 | 2017-08-02 |
| 1588957476 | Northeast Arkansas Community Mental Health Center | Counselor | 661 Addison Dr., Wynne, AR 72396 | 2011-05-25 |
| 1417106493 | Katherine Danielle Calhoun | Dietitian, Registered | 1013 Bridges Ave East, Wynne, AR 72396 | 2008-09-15 |
| 1053531319 | George Scott Puryear, Dds, Pa | Dentist | 715 East Eldrdige Avenue, Wynne, AR 72396 | 2007-04-27 |
| 1730245465 | Marilyn J Cullum | Counselor | 1742 Falls Blvd. Suite 5, The Logan Center, Wynne, AR 72396 | 2006-12-28 |
| 1770655185 | Robert Walton Bassham | Dentist | 669 Addison Drive, Wynne, AR 72396 | 2006-11-14 |
| 1073683827 | George Scott Puryear Jr. | Dentist | 715 E. Eldridge Ave, Wynne, AR 72396 | 2006-11-09 |
| 1194809517 | Richard Keeter Toland | Dentist | 2100 North Killough, Wynne, AR 72396 | 2006-10-24 |
| Find all providers in zip 72396 | ||||
| Taxonomy Code | 152WC0802X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Specialization | Corneal and Contact Management |
| The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea’s ability to sustain successful contact lens wear, and treatment of any external eye or corneal condition which can affect contact lens wear. |
| Notes: Source: American Optometric Association [1/1/2009: added definition, added source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568597409 | Kerry Childers, O.d., P.a. | Optometrist | 618 Julia Ave E, Wynne, AR 72396-3504 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750595757 | Dr. Clifford M Turner II Od | Optometrist | 116 East Second St., Carlisle, AR 72024-0859 | 2007-05-09 |
| 1316166697 | Icem E Brewer | Optometrist | 4201 N Shiloh Dr Ste 1235, Fayetteville, AR 72703-5303 | 2007-04-24 |
| 1598836066 | Rick D Ray | Optometrist | 2 Riviera Dr, Booneville, AR 72927-0295 | 2006-11-13 |
| 1780773481 | Chris Deitrick Od Pa | Optometrist | 202 Peabody St, Mountain View, AR 72560-1460 | 2006-10-12 |
| 1194817676 | Robert Frank Castiglione | Optometrist | 787 6th St, Little Rock Air Force Base, AR 72099-4947 | 2006-09-29 |
| 1124028493 | Charles G Crosslin | Optometrist | 7345 Highway 62 W, Gassville, AR 72635 | 2005-07-28 |
| 1669470183 | Chris Deitrick | Optometrist | 202 Peabody, Mountain View, AR 72560 | 2005-07-08 |
| 1801100623 | Patrick Fowler O.d. P.a. | Optometrist | 5501 S Olive St, Pine Bluff, AR 71603-7607 | 2010-08-04 |
| 1669591129 | Richard Foster | Optometrist | 2000 John Harden Dr, Jacksonville, AR 72076-2730 | 2007-03-28 |
| 1518043348 | J Brian Gray Od Pa | Optometrist | 114 E Oak Ave, Jonesboro, AR 72401-3561 | 2006-10-27 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.