Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shane Kinzer, OD

Individual provider Optometrist · NPI 1427755511

Shane Kinzer, OD is an Optometry in Moscow, Idaho. Graduated from Pacific University - College of Optometry in 2023, 3 years ago. Practices with Wilson Polito PLLC, a 4-clinician group and accepts Medicare assignment. Licensed in Idaho.

Years since qualifying
3
Trained at
Pacific University - College of Optometry
Licensed in
ID
In the registry since
2023
What do these letters mean?
OD — Doctor of Optometry
An optometrist: examines eyes, prescribes glasses and contacts, and treats many eye conditions.

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Practice location Address checks out

1844 W Pullman Rd
Moscow, ID 83843-4014
Phone: (208) 883-1800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Optometrist (primary) Taxonomy 152W00000X · Licence 100626 (ID)

Record details

NPI number1427755511
Entity typeIndividual (Type 1)
GenderMale
Credentials OD
Sole proprietorNo
NPI enumeratedFebruary 9, 2023
Last updated in NPPESJuly 19, 2023
Certification dateJuly 19, 2023
Mailing address1844 W Pullman Rd, Moscow, ID 83843-4014

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOPTOMETRY
Medical schoolPACIFIC UNIVERSITY - COLLEGE OF OPTOMETRY
Graduated 2023 (3 years in practice)
Group practice Wilson Polito Pllc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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