KELLY C-K TIERNEY (OD) – Optometrist, NPI 1073706578

KELLY C-K TIERNEY (OD) is a healthcare provider. based in Flint, Michigan. specializing in OPTOMETRY. They hold the professional credentials OD. They hold a License No. 5725 (OH). The NPI Number for KELLY C-K TIERNEY (OD) is 1073706578

Main info

Female
19 Years Of Experience
Accepts Medicare Assignment
Name
KELLY C-K TIERNEY (OD)
NPI
1073706578
Phone
(810) 720-9111
Address
4281 LENNON RD
Enumeration Date
20 August 2007
Last Update Date
26 September 2012

Doctor Profile

Medical School Name
OTHER
Secondary Phone
2486664020
Graduation Year
2007 (19 years ago)
PAC ID
8022195155
Group Practice PAC ID
9931257110
Professional Enrollment ID
I20120928000504
Address ID
MI483271502WA7084XRDXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience59
Completeness75
Years active:18State licenses:2Digital endpointsOther names

1,203 OPTOMETRY in MI

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Provider Addresses for KELLY C-K TIERNEY (OD)

  • 4281, West Lennon Road, Lennon, Flint Township, Genesee County, Michigan, 48507, United States

    FLINT, MI 485071024

    Phone: (810) 720-9111

    Fax: (810) 720-9119

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 2 Open Payments records for all available years, with a total value of $39.

Total Amount is formed as General ($39) + Research ($0) + Ownership ($0) = $39.

Last reported payment date: 2023-06-07 • Largest payer in this snapshot: Johnson & Johnson Vision Care, Inc. ($25).

Total Amount

$39

General + Research + Ownership

Payments

2

Total payment records

General Amount

$39

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-06-07

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2012-09-28

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20120928000504IOptometryMITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 48507)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 9931257110View full group profile
NameSpecialtyState
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI
O P T O M E T R YMI

Reviews

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Frequently asked questions

What is the standard ID for KELLY C-K TIERNEY (OD) in the U.S.?
In the U.S., KELLY C-K TIERNEY (OD) is identified by NPI 1073706578.
Should I treat KELLY C-K TIERNEY (OD) as an active provider?
Patients and plans typically see KELLY C-K TIERNEY (OD) as active in the national extract.
Which specialty label fits KELLY C-K TIERNEY (OD)?
NPPES ties KELLY C-K TIERNEY (OD) to Optometrist in the taxonomy section. Clinical services aligned with this taxonomy classification.
What city is tied to KELLY C-K TIERNEY (OD)?
The directory associates KELLY C-K TIERNEY (OD) with Flint, Michigan. Check all listed addresses for suites or satellite offices.
Why is information missing for KELLY C-K TIERNEY (OD)?
Providers choose how much contact data to publish. Missing fields do not mean the profile is fake.

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