Individual provider Active NPI

Michael R. Cozzetta, O.D.

  • Optometrist
  • Pueblo, CO
National Provider Identifier
1043277973
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1347 Issued in CO
Practice address
1620 Fortino Blvd
Pueblo, CO 81008-1856
Phone
(719) 542-3555
Fax
(719) 542-0776
NPI assigned
Apr 26, 2006
Last updated
Jun 28, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1347 CO Primary

Addresses

Primary practice location

1620 Fortino Blvd
Pueblo, CO 81008-1856

Mailing address

1620 Fortino Blvd
Pueblo, CO 81008-1856
Phone (719) 542-3555

Other identifiers 5

IdentifierTypeStateIssuer
1376983924OtherGROUP NPI
1679525208OtherGROUP OFFICE NPI
1679744841OtherOFFICE NPI
8013476MedicaidCO
410014546OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050922001163 CO Practitioner - Optometry 3375439367 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Eye Care Associates PCGroup PAC ID 7214055672, 4 clinicians

Practice addresses (Care Compare)

1620 Fortino Blvd
Pueblo, CO 81008-1856

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1347COMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Bright Eyes Vision Clinic PC a Colorado Professional Corporation Optometrist CurrentSince Apr 15, 2000 Accepting new patients
Bright Eyes Vision Clinic PC a Colorado Professional Corporation Optometrist Past Accepting new patients
Bright Eyes Vision Clinic PC a Colorado Professional Corporation Optometrist Past Accepting new patients
Bright Eyes Vision Clinic PC a Colorado Professional Corporation Optometrist Past Accepting new patients
Bright Eyes Vision Clinic PC a Colorado Professional Corporation Optometrist Past Accepting new patients
Bright Eyes Vision Clinic PC a Colorado Professional Corporation Optometrist Past Accepting new patients

Locations

326 Dozier Ave
Canon City, CO 81212
Phone (719) 276-0344

1620 Fortino Blvd
Pueblo, CO 81008
Phone (719) 542-3555

Networks

  • CO HMO
  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • CO HMO D-SNP
  • CO HMO C-SNP

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372377600000",
    "number": "1043277973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081856",
            "telephone_number": "719-542-3555",
            "fax_number": "719-542-0776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 FORTINO BLVD",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810081856",
            "telephone_number": "719-542-3555",
            "fax_number": "719-542-0776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COZZETTA",
        "first_name": "MICHAEL",
        "middle_name": "R.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-26",
        "last_updated": "2013-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1376983924",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP OFFICE NPI",
            "identifier": "1679525208",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OFFICE NPI",
            "identifier": "1679744841",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8013476",
            "state": "CO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "410014546",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.