Individual provider Active NPI

Rex M Roberson, O.D.

  • Optometrist
  • Highlands Ranch, CO
National Provider Identifier
1104875079
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1238 Issued in CO
Practice address
200 W County Line Rd
150
Highlands Ranch, CO 80129-2360
Phone
(303) 794-2433
Fax
(303) 730-3019
NPI assigned
May 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1238 CO Primary

Addresses

Primary practice location

200 W County Line Rd
150
Highlands Ranch, CO 80129-2360

Mailing address

6043 S Steele St
Centennial, CO 80121-3061
Phone (303) 795-6171

Other identifiers 1

IdentifierTypeStateIssuer
08123804MedicaidCO

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
I20101012000638 CO Practitioner - Optometry 5193917961 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Colorado PCGroup PAC ID 7113359415, 58 clinicians

Practice addresses (Care Compare)

200 W County Line Rd
Suite 150
Highlands Ranch, CO 80129-2361
Phone (303) 794-2433

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1238COMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Colorado PC Optometrist CurrentSince Oct 19, 2019 Accepting new patients
Myeyedr Optometry of Colorado PC Optometrist CurrentSince Oct 19, 2019 Accepting new patients
Myeyedr Optometry of Colorado PC Optometrist Current Accepting new patients

Locations

200 W County Line Rd
Ste 150
Highlands Ranch, CO 80129
Phone (303) 794-2433

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1104875079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6043 S STEELE ST",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801213061",
            "telephone_number": "303-795-6171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W COUNTY LINE RD",
            "address_2": "150",
            "city": "HIGHLANDS RANCH",
            "state": "CO",
            "postal_code": "801292360",
            "telephone_number": "303-794-2433",
            "fax_number": "303-730-3019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERSON",
        "first_name": "REX",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-09",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "1238",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08123804",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Highlands Ranch, CO

Sources for this page

Verify at the official NPI Registry.