Active NPI
Mark Leroy Bottelson, O.D.
- Optometrist
- Windsor Heights, IA
National Provider Identifier
1689859704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 01684
- Practice address
- 1001 73Rd St
Vision Center
Windsor Heights, IA 50324-1311 - Phone
- (515) 274-6452
- Fax
- (515) 274-6306
- NPI assigned
- Jan 8, 2008
- Last updated
- Jul 13, 2009
- 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 | 01684 | IA | Primary |
Addresses
Primary practice location
1001 73Rd St
Vision Center
Windsor Heights, IA 50324-1311
Mailing address
1001 73Rd St
Vision Center
Windsor Heights, IA 50324-1311
Phone (515) 274-6452
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 238377 | Other | IA | COVENTRY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01684 | IA | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1199750400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247443200000",
"number": "1689859704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1001 73RD ST",
"address_2": "VISION CENTER",
"city": "WINDSOR HEIGHTS",
"state": "IA",
"postal_code": "503241311",
"telephone_number": "515-274-6452",
"fax_number": "515-274-6306"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 73RD ST",
"address_2": "VISION CENTER",
"city": "WINDSOR HEIGHTS",
"state": "IA",
"postal_code": "503241311",
"telephone_number": "515-274-6452",
"fax_number": "515-274-6306"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOTTELSON",
"first_name": "MARK",
"middle_name": "LEROY",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-01-08",
"last_updated": "2009-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "IA",
"license": "01684",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COVENTRY",
"identifier": "238377",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Windsor Heights, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.