Individual provider Active NPI

Karen Elaine Manko, O.D.

  • Optometrist
  • Fort Mitchell, KY
National Provider Identifier
1487900494
Registry record updated Apr 19, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1904DT Issued in KY
Practice address
2174 Dixie Hwy
Fort Mitchell, KY 41017-2972
Phone
(859) 341-2566
Fax
(859) 341-2568
NPI assigned
Jul 27, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1904DT KY Primary

Addresses

Primary practice location

2174 Dixie Hwy
Fort Mitchell, KY 41017-2972

Mailing address

178 Picketts Charge
Fort Thomas, KY 41075-1469
Phone (859) 341-2566

Other identifiers 2

IdentifierTypeStateIssuer
1904DTOtherKYSTATE LICENSE
7100217150MedicaidKY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20120807000739 KY Practitioner - Optometry 2163678178 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dr Shewmaker and Associates Optometrists Inc 5 clinicians

Practice addresses (Care Compare)

2174 Dixie Hwy
Suite a
Fort Mitchell, KY 41017-2972
Phone (859) 341-2566

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1904DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr Shewmaker & Associates Optometrists Inc Optometrist CurrentSince Sep 1, 2012 Accepting new patients
Dr Shewmaker & Associates Optometrists Inc Optometrist PastSince Sep 1, 2012 Accepting new patients

Locations

1114 Fashion Ridge Rd
Dry Ridge, KY 41035
Phone (859) 824-4415

2174 Dixie Hwy
Ft Mitchell, KY 41017
Phone (606) 341-2566

2174 Dixie Hwy
Ste A
Ft Mitchell, KY 41017
Phone (859) 341-2566

Organizations & group practices 2

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": "1343347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1366329600000",
    "number": "1487900494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 PICKETTS CHARGE",
            "city": "FORT THOMAS",
            "state": "KY",
            "postal_code": "410751469",
            "telephone_number": "859-341-2566",
            "fax_number": "859-341-2568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2174 DIXIE HWY",
            "city": "FORT MITCHELL",
            "state": "KY",
            "postal_code": "410172972",
            "telephone_number": "859-341-2566",
            "fax_number": "859-341-2568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANKO",
        "first_name": "KAREN",
        "middle_name": "ELAINE",
        "name_prefix": "Ms.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-27",
        "last_updated": "2013-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1904DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "1904DT",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100217150",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Mitchell, KY

Sources for this page

Verify at the official NPI Registry.