Individual provider Active NPI

David Robert Kolker, O.D.

  • Optometrist
  • Tulsa, OK
National Provider Identifier
1073618211
Registry record updated Nov 30, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1110 Issued in OK
Practice address
11711 S Hudson PL
Tulsa, OK 74137-8530
Phone
(918) 298-4969
Fax
(918) 298-4969
NPI assigned
Sep 13, 2006
Last updated
Nov 30, 2009By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 30, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1110 OK Primary

Addresses

Primary practice location

11711 S Hudson PL
Tulsa, OK 74137-8530

Mailing address

11711 S Hudson PL
Tulsa, OK 74137-8530
Phone (918) 298-4969

Other identifiers 1

IdentifierTypeStateIssuer
100765700AMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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
I20040428000559 OK Practitioner - Optometry 6002803418 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

119 N 6TH St
Okeene, OK 73763-9135
Phone (918) 381-9363

12109 S 83Rd E Ave
Apt 108
Bixby, OK 74008-3326
Phone (918) 298-4969

Merit-based Incentive Payment System (MIPS)

Final score
99.82 of 100Reported as individual
Quality
79.64
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1110OKMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
DRK Vision Group PLLC Optometrist CurrentSince Nov 29, 2016 Accepting new patients
Med Southwest, PLLC Optometrist Current Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Nov 15, 2021 Accepting new patients
Med Southwest, PLLC Optometrist CurrentSince Nov 15, 2021 Accepting new patients
Andrea B Dudley OD, Inc PC Optometrist PastSince Jun 15, 2011 Accepting new patients
Kolker Vision Care Optometrist Past Accepting new patients

Locations

1709 S Main St
Broken Arrow, OK 74012
Phone (918) 251-2626

801 Highway 48
Holdenville, OK 74848
Phone (405) 379-6671

1425 E Lincoln Rd
Ste A1
Idabel, OK 74745
Phone (580) 286-6000

301 E Dale St
Norman, OK 73069
Phone (405) 217-4786

11063D S Memorial Dr
Unit 515
Tulsa, OK 74133
Phone (918) 398-4969

111 S Lewis Ave
Tulsa, OK 74104
Phone (918) 582-2020

4520 S Harvard Ave
Ste 135
Tulsa, OK 74135
Phone (918) 745-9662

8215 S Mingo Rd
Ste 100
Tulsa, OK 74133
Phone (918) 252-7432

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Interoperability endpoints

  • Direct secure messaging: dkolker@direct.revolutionehr.com

Organizations & group practices 7

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1259539200000",
    "number": "1073618211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11711 S HUDSON PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741378530",
            "telephone_number": "918-298-4969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11711 S HUDSON PL",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741378530",
            "telephone_number": "918-298-4969",
            "fax_number": "918-298-4969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLKER",
        "first_name": "DAVID",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-13",
        "last_updated": "2009-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "1110",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100765700A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

Verify at the official NPI Registry.