Individual provider Active NPI

Robert E Lesko, O.D.

  • Optometrist
  • Kokomo, IN
National Provider Identifier
1306884200
Registry record updated Dec 11, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002751 Issued in IN
Practice address
104 N Dixon Rd
Kokomo, IN 46901-4154
Phone
(765) 459-3937
Fax
(765) 459-4430
NPI assigned
Jun 3, 2006
Last updated
Dec 11, 2012By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 11, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002751 IN Primary

Addresses

Primary practice location

104 N Dixon Rd
Kokomo, IN 46901-4154

Mailing address

104 N Dixon Rd
Kokomo, IN 46901-4154
Phone (765) 459-3937

Other identifiers 1

IdentifierTypeStateIssuer
200076890MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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
I20070320000648 IN Practitioner - Optometry 3274636873 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

104 N Dixon Rd
Kokomo, IN 46901-4154
Phone (765) 459-3937

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18002751INMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
20 20 Vision Inc Optometrist CurrentSince Nov 21, 2012 Accepting new patients
Christopher J. Wolf, OD, Inc Optometrist Past Accepting new patients
20-20 Vision, Inc. PastSince Nov 21, 2012 Accepting new patients
Northern Indiana Optometrists, PC Optometrist Past Accepting new patients

Locations

104 N Dixon Rd
Kokomo, IN 46901
Phone (765) 452-0071

Organizations & group practices 4

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": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1355184000000",
    "number": "1306884200",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 N DIXON RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014154",
            "telephone_number": "765-459-3937",
            "fax_number": "765-459-4430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 N DIXON RD",
            "city": "KOKOMO",
            "state": "IN",
            "postal_code": "469014154",
            "telephone_number": "765-459-3937",
            "fax_number": "765-459-4430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LESKO",
        "first_name": "ROBERT",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-03",
        "last_updated": "2012-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200076890",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kokomo, IN

Sources for this page

Verify at the official NPI Registry.