Mark L. Bottelson, O.D. and Associates, P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1684 Issued in IA

Legal business name

MARK L. BOTTELSON, O.D. AND ASSOCIATES, P.C.

Practice address

1001 73Rd St
Vision Center
Windsor Heights, IA 50324-1311

Phone

(515) 274-6452

Fax

(515) 274-6306

NPI assigned

Oct 15, 2005

Last updated

Jul 13, 2009By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Elaine Rahe Bottelson

Title

Insurance Manager

Phone

(515) 274-6452

Specialties & licenses 1

Addresses

Other identifiers 5

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

{
    "created_epoch": "1129334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1247443200000",
    "number": "1740279470",
    "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": {
        "organization_name": "MARK L. BOTTELSON, O.D. AND ASSOCIATES, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-15",
        "last_updated": "2009-07-13",
        "status": "A",
        "authorized_official_last_name": "BOTTELSON",
        "authorized_official_first_name": "ELAINE",
        "authorized_official_middle_name": "RAHE",
        "authorized_official_title_or_position": "INSURANCE MANAGER",
        "authorized_official_telephone_number": "515-274-6452",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "1684",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3167973",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDLANDS CHOICE",
            "identifier": "6151",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL VISION ADMIN.",
            "identifier": "551764",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "36759",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIVATE HEALTH CARE SYSTE",
            "identifier": "9391471",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• 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.

Verify at the official NPI Registry.