Active NPI
Nicholas Matthew Kofos, OD
- Optometrist
- Marlborough, MA
National Provider Identifier
1447244637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3264
- Practice address
- 180 Bolton St
Marlborough, MA 01752-3934 - Phone
- (508) 485-0736
- Fax
- (508) 481-7532
- NPI assigned
- Sep 2, 2005
- Last updated
- May 7, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3264 | MA | Primary |
Addresses
Primary practice location
180 Bolton St
Marlborough, MA 01752-3934
Mailing address
180 Bolton St
Marlborough, MA 01752-3934
Phone (508) 485-0736
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0392227 | Medicaid | MA | |
| U47255 | Other | MA | HARVARD PILGRIM |
| 772575 | Other | MA | TUFTS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101117000044 | MA | Practitioner - Optometry | 2264551225 | Practice locations: Marlborough, MA |
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- New England College of Optometry, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
180 Bolton St
Marlborough, MA 01752-3934
Phone (508) 485-0736
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1336348800000",
"number": "1447244637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 BOLTON ST",
"city": "MARLBOROUGH",
"state": "MA",
"postal_code": "017523934",
"telephone_number": "508-485-0736",
"fax_number": "508-481-7532"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 BOLTON ST",
"city": "MARLBOROUGH",
"state": "MA",
"postal_code": "017523934",
"telephone_number": "508-485-0736",
"fax_number": "508-481-7532"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KOFOS",
"first_name": "NICHOLAS",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-02",
"last_updated": "2012-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MA",
"license": "3264",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0392227",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HARVARD PILGRIM",
"identifier": "U47255",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TUFTS",
"identifier": "772575",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Marlborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2012; 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.