DR. KENNY J WYATT (NPI# 1427056951) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427056951 |
| Entity Type | Individual |
| Full Name | DR. KENNY J WYATT |
| Credential | OD |
| Practice Address |
202 Peabody Mountain View AR 72560 |
| Mailing Address |
Po Box 1460 Mountain View AR 72560-1460 |
| Practice Telephone | 8702693610 |
| Practice Fax Number | 8702695086 |
| Mailing Telephone | 8702693610 |
| Mailing Fax Number | 8702695086 |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2010-04-21 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152WC0802X |
Optometrist Specialization: Corneal and Contact Management |
2209 | AR | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AR | 106031722 | 05 | |
| AR | QUALCHOICE ID # | 16064000040 | 01 |
| AR | MEDICARE RR ID # | P00135331 | 01 |
| Street Address |
202 PEABODY |
| City | MOUNTAIN VIEW |
| State | AR |
| Zip Code | 72560 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669470183 | Chris Deitrick | Optometrist | 202 Peabody, Mountain View, AR 72560 | 2005-07-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558979781 | Creoks Mental Health Services, Inc | Clinic/Center | 301 Industrial Road, Mountain View, AR 72560 | 2020-07-14 |
| 1194377861 | John Randolph Crone II | Physical Therapist | 103 Mountain Place Drive, Mountain View, AR 72560 | 2019-07-12 |
| 1154898161 | Candace Casey Lane | Physical Therapy Assistant | 260 Hickory Circle, Mountain View, AR 72560 | 2018-10-29 |
| 1780102210 | Janet Karen Watkins | Developmental Therapist | 1810 Ozarka College Drive, Mountain View, AR 72560 | 2017-09-05 |
| 1861928038 | Jason Nope | Registered Nurse | 217 Brewer Avenue, Mountain View, AR 72560 | 2017-05-10 |
| 1013377415 | Charles Grinder | Nurse Practitioner | 102 Mountain Place Dr Ste C, Mountain View, AR 72560 | 2016-02-26 |
| 1912365982 | Baxter Regional Health System | Family Medicine | 102 Mountain Place Drive, Suite C, Mountain View, AR 72560 | 2016-02-05 |
| 1790142859 | Baxter Regional Health System | Nurse Practitioner | 803 W Main St., Mountain View, AR 72560 | 2016-01-20 |
| 1518337732 | Beverly Clark | Nurse Practitioner | 803 West Main Street, Mountain View, AR 72560 | 2015-09-30 |
| 1447503941 | Mitchell's Main Street Pharmacy, Inc | Pharmacy | 214 East Main St, Mountain View, AR 72560 | 2012-10-22 |
| Find all providers in zip 72560 | ||||
| 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 |
|---|---|---|---|---|
| 1780773481 | Chris Deitrick Od Pa | Optometrist | 202 Peabody St, Mountain View, AR 72560-1460 | 2006-10-12 |
| 1669470183 | Chris Deitrick | Optometrist | 202 Peabody, Mountain View, AR 72560 | 2005-07-08 |
| 1588179857 | Dr. Yura Kim, Od | Optometrist | 644 San Antonio Rd, Mountain View, CA 94040-1304 | 2017-12-08 |
| 1891060737 | Yura Kim | Optometrist | 644 San Antonio Rd, Mountain View, CA 94040-1304 | 2012-03-10 |
| 1427108026 | Michael Adey | Optometrist | 555 Castro St, Mountain View, CA 94041-2009 | 2007-01-12 |
| 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 |
| 1568597409 | Kerry Childers, O.d., P.a. | Optometrist | 618 Julia Ave E, Wynne, AR 72396-3504 | 2007-02-22 |
| 1598836066 | Rick D Ray | Optometrist | 2 Riviera Dr, Booneville, AR 72927-0295 | 2006-11-13 |
| 1194817676 | Robert Frank Castiglione | Optometrist | 787 6th St, Little Rock Air Force Base, AR 72099-4947 | 2006-09-29 |
| 1114906310 | Kerry K Childers | Optometrist | 723 Falls Blvd S, Ste A, Wynne, AR 72396-3508 | 2006-01-16 |
| 1124028493 | Charles G Crosslin | Optometrist | 7345 Highway 62 W, Gassville, AR 72635 | 2005-07-28 |
| 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 | ||||
| City | MOUNTAIN VIEW |
| Zip Code | 72560 |
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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.