Cody Philip Blom, O.D.
Individual provider Active NPI Optometrist · Butte, MT
NPI 1265026033 · NPPES record last updated Feb 23, 2021
Key facts
- NPI
- 1265026033
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3974 (MT)
- Practice address
- 1221 Dewey Blvd
Butte, MT 59701-3413 - Phone
- (406) 494-2222
- NPI assigned
- Feb 23, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Pacific University - College of Optometry, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Vital Vision PLLC
Serendipity Eyecare
Practice addresses (Care Compare)
270 W Kagy Blvd
Suite B
Bozeman, MT 59715-6055
Phone (406) 404-1666
280 W Kagy Blvd
Suite B
Bozeman, MT 59715-6056
Phone (406) 522-8888
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 18 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210301002618 | MT | Practitioner - Optometry | 6608282546 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3974 | MT | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Vital Vision PLLC | Optometrist | Current |
Accepting new patients |
| Serendipity Eyecare | Optometrist | Current |
Accepting new patients |
Locations
280 W Kagy Blvd
Ste B
Bozeman, MT 59715
Phone (406) 522-8888
270 W Kagy Blvd
Ste B
Bozeman, MT 59715
Phone (406) 404-1375
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3974 | MT | Yes |
Addresses
Primary practice location
1221 Dewey Blvd
Butte, MT 59701-3413
Mailing address
2780 Tempest CT
Bozeman, MT 59718-6109
Phone (406) 498-0267
Other practice location 1
270 W Kagy Blvd Ste B
Bozeman, MT 59715-6055
Phone (406) 404-1375
Other practice location 2
280 W Kagy Blvd
Bozeman, MT 59715-6056
Phone (406) 522-8888
Other providers in Butte, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 23, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.