Michael Kotlicky, O.D.

Primary specialty

Vision Therapy OptometristTaxonomy code 152WV0400X

License

TA0750 Issued in MD

Practice address

8827 Columbia 100 Pkwy Ste 3
The Signature Centre
Columbia, MD 21045-2178

Phone

(410) 730-5808

Fax

(410) 730-5893

NPI assigned

Nov 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Apr 1, 2020 through Apr 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1163980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093889024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8827 COLUMBIA 100 PKWY STE 3",
            "address_2": "THE SIGNATURE CENTRE",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452178",
            "telephone_number": "410-730-5808",
            "fax_number": "410-730-5893"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8827 COLUMBIA 100 PKWY STE 3",
            "address_2": "THE SIGNATURE CENTRE",
            "city": "COLUMBIA",
            "state": "MD",
            "postal_code": "210452178",
            "telephone_number": "410-730-5808",
            "fax_number": "410-730-5893"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOTLICKY",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WV0400X",
            "taxonomy_group": "",
            "desc": "Optometrist, Vision Therapy",
            "state": "MD",
            "license": "TA0750",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Poonum Korpe, MD
• Sophia Anntionette Kosh, M.A.
• Razia Fathima Kosi, LCSW-C
• Morufat Olakunbi Kosoko, MD
• Julie Marks Kotler, LCPC, ATR-BC
• Valerie B Kouabran
• Nicholas William Koutrelakos, M.D.
• Jennifer Kouvaris, RN
• Bernice Kpadjiba, PA-C
• Felicia Gabrielle Kraft, LCSW-C

• Vision Therapy Optometrist in Columbia, MD
• Providers in Columbia, MD by specialty
• Vision Therapy Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.