Lee Theodore Bottem, D.O.

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4175 Issued in OK

Practice address

4700 W Urbana St
Broken Arrow, OK 74012-5997

Phone

(918) 290-2300

Fax

(918) 290-2310

NPI assigned

Apr 1, 2008

Last updated

Sep 6, 2019By the provider in NPPES

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 OK

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: drleebottem@lbdp-ok.direct.office.nextgen.com
• Direct secure messaging: lbottem289239@ahs.direct-ci.com

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.

• Lee Bottem, D.O., PLC

  • Ophthalmology Physician
  • Broken Arrow, OK
  • NPI 1104157296
  Authorized official Same address or phone
• Lee Bottem DO PLC

  • Ophthalmology Physician
  • Muskogee, OK
  • NPI 1700254661
  NPD (past)
• Marc a Goldberg MD PC

  dba Marc A Goldberg MD Optical

  • Eyewear Supplier
  • Tulsa, OK
  • NPI 1174836241
  NPD (past)
• Restore Dermatology Clinic LLC

  • Dermatology Physician
  • Broken Arrow, OK
  • NPI 1336002302
  NPD (past)
• Trinity Salem Family Health Clinic PLLC

  • Family Medicine Physician
  • Waxahachie, TX
  • NPI 1760119440
  NPD (past)

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

{
    "created_epoch": "1207008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567728000000",
    "number": "1679745418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 W URBANA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125997",
            "telephone_number": "918-290-2300",
            "fax_number": "918-290-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 W URBANA ST",
            "city": "BROKEN ARROW",
            "state": "OK",
            "postal_code": "740125997",
            "telephone_number": "918-290-2300",
            "fax_number": "918-290-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTTEM",
        "first_name": "LEE",
        "middle_name": "THEODORE",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-01",
        "last_updated": "2019-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OK",
            "license": "4175",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ayla Gabrielle Bonomi
• Mea Elizabeth Boone, PT
• Mitzi Davis Booth, MS, CCC-SLP
• Maresa Boshoff, PHARMACIST
• Jillian Boss
• Bowden McElroy and Associates, LLC
• Clayton Bowen
• John Clay Bowen, DO
• Amanda Gail Bowles, M.S., CCC-SLP
• Dwain Bowline, LMFT

• Ophthalmology Physician in Broken Arrow, OK
• Providers in Broken Arrow, OK by specialty
• Ophthalmology Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2019; 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.