Kory Botelho, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

60660393 Issued in WA

Practice address

411 Strander Blvd Ste 202
Tukwila, WA 98188-2959

Phone

(206) 575-4396

Fax

(206) 575-4396

NPI assigned

Sep 1, 2016

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 WA

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, 2016

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Max Vision PLLCGroup PAC ID 7911311444, 3 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.

• Max Vision PLLC

  • Optometrist
  • Tukwila, WA
  • NPI 1518560184
  Medicare reassignment Care Compare group NPD Authorized official
• Kyle Sexton, O.D., LLC

  • Optometrist
  • Puyallup, WA
  • NPI 1972778009
  Medicare reassignment NPD
• David R Benson MD OD PLLC

  • Ophthalmology Physician
  • Lakewood, WA
  • NPI 1346412483
  NPD (past)
• James C. Simmons

  • Optometrist
  • Tukwila, WA
  • NPI 1467688945
  NPD (past)

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

{
    "created_epoch": "1472688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1407302003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 STRANDER BLVD STE 202",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882959",
            "telephone_number": "206-575-4396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 STRANDER BLVD STE 202",
            "city": "TUKWILA",
            "state": "WA",
            "postal_code": "981882959",
            "telephone_number": "206-575-4396",
            "fax_number": "206-575-4396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTELHO",
        "first_name": "KORY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-09-01",
        "last_updated": "2022-06-21",
        "certification_date": "2022-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "60660393",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kevin Ray Boren, LMHC, CDP, LPC, NCC
• Sarah Shevonne Borger, LMHCA, ATR-P
• Kristine Joy Borgonia
• Christopher Brian Borgstadt, BA
• Hannah Borja
• Boualoys Massage LLC
• Anca Maria Boudreaux, LMHC, NCC
• Phoukham Kelly Bounkeua, PHD
• Kumiko Mizutani Boutz, LMHC
• Natalie Bowerman

• Optometrist in Tukwila, WA
• Providers in Tukwila, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; 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.