{"npi":"1467930735","type":"NPI-1","status":"active","name":{"display":"Kaylyn Nickelson OD","other":[{"code":"1","type":"Formerly known as","value":"YAKEL, KAYLYN MARIE"}],"first":"KAYLYN","last":"NICKELSON","middle":"MARIE","credential":"OD"},"specialty":{"primary_taxonomy":"152W00000X","primary_taxonomy_description":"Optometrist","slug":"optometrist","schema_org_specialty":null,"all":[{"code":"152W00000X","description":"Optometrist","primary":true,"state":"IL","license":"046011215"}]},"addresses":[{"purpose":"LOCATION","street_1":"2020 W ILES AVE","city":"SPRINGFIELD","state":"IL","postal_code":"627047015","country_code":"US","phone":"2176983030","fax":"2177185687"},{"purpose":"MAILING","street_1":"2020 W ILES AVE","city":"SPRINGFIELD","state":"IL","postal_code":"627047015","country_code":"US","phone":"2176983030","fax":"2176984728"}],"license":{"state":"IL","number":"046011215"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"046011215","state":"IL","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20180829000000","type_code":"14-41","type_desc":"PRACTITIONER - OPTOMETRY","state":"IL","pac_id":"3779833587"}]},"enumeration_date":"2018-07-30","last_updated":"2025-03-18","_meta":{"source":"NPPES","snapshot_date":"2025-03-18","doc_url":"https://findmynpi.com/api"}}