Carbon Valley Eye Care

Primary specialty

OptometristTaxonomy code 152W00000X

License

2850 Issued in CO

Legal business name

CARBON VALLEY EYE CARE

Doing business as

Carbon Valley Eye Care

Practice address

5900 Keyes St Ste 101
Frederick, CO 80504-5956

Phone

(303) 833-1056

Fax

(303) 833-1057

NPI assigned

Apr 9, 2014

Last updated

Mar 13, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Michael Koditek, ODNPI 1366735201

Title

President

Phone

(303) 833-1056

Specialties & licenses 1

Addresses

Other names 1

• Carbon Valley Eye Care Doing business as

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Edward Koditek, O.D.

  • Optometrist
  • Frederick, CO
  • NPI 1366735201
  Medicare reassignment Care Compare group NPD Authorized official
• Michael Andrew Bagley, OD

  • Optometrist
  • Frederick, CO
  • NPI 1114380482
  Medicare reassignment Care Compare group NPD
• Craig Brown, OD

  • Optometrist
  • Fort Collins, CO
  • NPI 1841808409
  Medicare reassignment Care Compare group NPD
• Taylor Kiyota Jackson, OD

  • Optometrist
  • Frederick, CO
  • NPI 1275158404
  Medicare reassignment Care Compare group NPD
• Ryan James Dugan, OD

  • Optometrist
  • Tucson, AZ
  • NPI 1497237408
  Care Compare group
• H Lindsay Wright, O.D.

  • Optometrist
  • Denver, CO
  • NPI 1922197540
  NPD (past)

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

{
    "created_epoch": "1397001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584057600000",
    "number": "1235558065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 KEYES ST STE 101",
            "city": "FREDERICK",
            "state": "CO",
            "postal_code": "805045956",
            "telephone_number": "303-833-1056",
            "fax_number": "303-833-1057"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 KEYES ST STE 101",
            "city": "FREDERICK",
            "state": "CO",
            "postal_code": "805045956",
            "telephone_number": "303-833-1056",
            "fax_number": "303-833-1057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARBON VALLEY EYE CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-09",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A",
        "authorized_official_last_name": "KODITEK",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-833-1056",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carbon Valley Eye Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Carbon Valley Eye Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Riley Nicole Buis, COTA/L
• Carolyn Deolinda Bullock, DDS
• Laura Michele Camp, MSN, NP
• Lindsay Campbell
• Carbon Valley Chiropractic
• Patricia Ann Carlson, MA, LPC
• Marc Derick Catbagan, PHARMD
• Catholic Health Initiatives Colorado (Centura Health Emergency and Urgent Care - Indian Peaks)
• Tara N Clemens, PA
• Shelby Lynn Coleman, PTA

• Optometrist in Frederick, CO
• Providers in Frederick, CO by specialty
• Optometrist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.