Individual provider Active NPI

Adam R Risko, OD

  • Optometrist
  • Kalamazoo, MI
National Provider Identifier
1386086064
Registry record updated Jun 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3010 Issued in CO
Practice address
4425 W Main St
Kalamazoo, MI 49006-2648
Phone
(269) 345-4425
Fax
(269) 345-4435
NPI assigned
Jul 23, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 4901004810 MI
Optometrist 152W00000X 3010 CO Primary

Addresses

Primary practice location

4425 W Main St
Kalamazoo, MI 49006-2648

Mailing address

4425 W Main St
Kalamazoo, MI 49006-2648
Phone (269) 345-4425

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20180606000841 MI Practitioner - Optometry 9739447251 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4425 W Main St
Kalamazoo, MI 49006-2648
Phone (269) 345-4425

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3010COMDClinical Psychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Adam R. Risko, OD PLLC Optometrist CurrentSince May 1, 2024 Accepting new patients

Locations

4425 W Main St
Kalamazoo, MI 49006
Phone (269) 345-4425

Organizations & group practices 1

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": "1374537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718150400000",
    "number": "1386086064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4425 W MAIN ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490062648",
            "telephone_number": "269-345-4425",
            "fax_number": "269-345-4435"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4425 W MAIN ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490062648",
            "telephone_number": "269-345-4425",
            "fax_number": "269-345-4435"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RISKO",
        "first_name": "ADAM",
        "middle_name": "R",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-07-23",
        "last_updated": "2024-06-12",
        "certification_date": "2024-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004810",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "3010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.