Michael Edward Koditek, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2850 Issued in CO

Practice address

5900 Keyes St Ste 101
Frederick, CO 80504-5956

Phone

(303) 833-1056

Fax

(303) 833-1057

NPI assigned

May 25, 2011

Sex

Male

Sole proprietor

Yes

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

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Carbon Valley Eye Care 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Carbon Valley Eye Care

  • Optometrist
  • Frederick, CO
  • NPI 1235558065

  CO, Optometrist

  Medicare reassignment Care Compare group NPD Authorized official
• H Lindsay Wright O.D., P.C.

  • Optometrist
  • Firestone, CO
  • NPI 1013154855
  NPD (past)

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

{
    "created_epoch": "1306281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1584057600000",
    "number": "1366735201",
    "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": {
        "last_name": "KODITEK",
        "first_name": "MICHAEL",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-05-25",
        "last_updated": "2020-03-13",
        "certification_date": "2020-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "2850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kersten Chiropractic PC
• Kersten Health, P.C.
• Kidney Center of Dacono LLC
• Kind Hearted Healthcare LLC
• Kodiak Corporation
• Veronica Kriss, PT, DPT
• Christina Lavely
• Toni Lavely
• Amanda Lynn Leonard, RDH, OMT
• Jacqueline Danielle Lewton, MA

• All providers in Frederick, CO
• 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; Order and Referring.
• 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.