Mark Matthew McKell, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100119 Issued in ID

Practice address

2100 Caldwell Blvd
Nampa, ID 83651-1510

Phone

(208) 466-6895

NPI assigned

Aug 25, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

University of Houston - College of Optometry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Salt Lake City Eye Care, LLC

  • Optometrist
  • Salt Lake City, UT
  • NPI 1952810731
  Medicare reassignment NPD Authorized official
• Lund Optical Company

  • Eyewear Supplier
  • Provo, UT
  • NPI 1477632669
  NPD (past)
• Usv Optical Inc

  • Eyewear Supplier
  • Blackwood, NJ
  • NPI 1578891008

  Optometrist

  NPD (past)
• Usv Optical Inc.

  • Eyewear Supplier
  • Provo, UT
  • NPI 1598779563
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396853974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 CALDWELL BLVD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836511510",
            "telephone_number": "208-466-6895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 CALDWELL BLVD",
            "city": "NAMPA",
            "state": "ID",
            "postal_code": "836511510",
            "telephone_number": "208-466-6895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKELL",
        "first_name": "MARK",
        "middle_name": "MATTHEW",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100119",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "6271198-9934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert B McDonald, DMD
• Barry McGarrah
• Brian J. McGourty, O.D.
• Linda McIntosh
• Christal McKay
• Todd Bryan McKeown, PTA
• McKim Chiropractic
• Joshua Keith McKim, D.C.
• Raymond Keith McKim, D.C.
• Samuel McKnight

• Optometrist in Nampa, ID
• Providers in Nampa, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.