NPIMap

Organization Active NPI

Madison Eye Care of Port Clinton LLC

  • Optometrist
  • Port Clinton, OH
National Provider Identifier
1427748243
Registry record updated May 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MADISON EYE CARE OF PORT CLINTON LLC
Practice address
820 Jefferson St
Port Clinton, OH 43452-2416
Phone
(419) 732-2828
NPI assigned
May 15, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 15, 2023

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

Authorized official

Name
Dr. Kyle Koubek, ODNPI 1629546668
Title
Doctor/Part Owner
Phone
(440) 892-5367

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

820 Jefferson St
Port Clinton, OH 43452-2416

Mailing address

26927 Detroit Rd
Westlake, OH 44145-2370
Phone (440) 892-5367

Other names 1

  • MADISON EYE CARE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230908000190 OH Part B Supplier - Clinic/Group Practice 3870957921 Receives reassigned benefits from 5 practitioners
Practice locations: Port Clinton, OH

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1684108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684108800000",
    "number": "1427748243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26927 DETROIT RD",
            "city": "WESTLAKE",
            "state": "OH",
            "postal_code": "441452370",
            "telephone_number": "440-892-5367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 JEFFERSON ST",
            "city": "PORT CLINTON",
            "state": "OH",
            "postal_code": "434522416",
            "telephone_number": "419-732-2828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON EYE CARE OF PORT CLINTON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-15",
        "last_updated": "2023-05-15",
        "certification_date": "2023-05-13",
        "status": "A",
        "authorized_official_last_name": "KOUBEK",
        "authorized_official_first_name": "KYLE",
        "authorized_official_title_or_position": "DOCTOR/PART OWNER",
        "authorized_official_telephone_number": "440-892-5367",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MADISON EYE CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Clinton, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.