Individual provider Active NPI

Aida I Badillo, OD

  • Optometrist
  • Louisville, KY
National Provider Identifier
1528065612
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1471DT Issued in KY
Practice address
7900 Shelbyville Rd Ste A15
Louisville, KY 40222-5463
Phone
(502) 327-8568
Fax
(502) 327-0613
NPI assigned
Jul 5, 2005
Last updated
Jun 26, 2019By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1471DT KY Primary
Optometrist 152W00000X 18003026 IN

Addresses

Primary practice location

7900 Shelbyville Rd Ste A15
Louisville, KY 40222-5463

Mailing address

5855 Reliable Pkwy
Chicago, IL 60686-0001
Phone (502) 955-2020

Other identifiers 2

IdentifierTypeStateIssuer
77000305MedicaidKY
200312800MedicaidIN

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
I20050330000545 KY Practitioner - Optometry 2365408275 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
International American University at Puerto Rico - School of Optometry, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ky Doctors of Optometry, PLLCGroup PAC ID 0941108732, 64 clinicians

Practice addresses (Care Compare)

4655 Outer Loop
Louisville, KY 40219-3970
Phone (502) 966-2020

500 Winchester Ave
Suite 810
Ashland, KY 41101-7362
Phone (606) 324-3672

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18003026INMDOptometrist
1471DTKYMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Ky Doctors of Optometry, PLLC Optometrist CurrentSince Sep 30, 2022 Accepting new patients
Clarkson Optometry Midwest Inc Optometrist Past Accepting new patients
20-20 Eyecare PSC Optometrist Past Accepting new patients

Locations

4655 Outer Loop
Louisville, KY 40219
Phone (502) 966-2020

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1120521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1528065612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5855 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "502-955-2020",
            "fax_number": "502-736-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 SHELBYVILLE RD STE A15",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225463",
            "telephone_number": "502-327-8568",
            "fax_number": "502-327-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BADILLO",
        "first_name": "AIDA",
        "middle_name": "I",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-05",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1471DT",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18003026",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "77000305",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200312800",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

Verify at the official NPI Registry.