Active NPI
Angela Costa, LLC
- Optometrist
- Lexington, KY
National Provider Identifier
1780940361
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1612DT
- Legal business name
- ANGELA COSTA, LLC
- Practice address
- 138 E Reynolds Rd
101
Lexington, KY 40517-1257 - Phone
- (859) 273-2020
- NPI assigned
- Apr 8, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Angela Costa, OD
- Title
- Co-Owner
- Phone
- (859) 273-2020
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1612DT | KY | Primary |
Addresses
Primary practice location
138 E Reynolds Rd
101
Lexington, KY 40517-1257
Mailing address
138 E Reynolds Rd
101
Lexington, KY 40517-1257
Phone (859) 273-2020
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120510000629 | KY | Part B Supplier - Clinic/Group Practice | 6901068881 |
Receives reassigned benefits from 3 practitioners Practice locations: Mt Sterling, KY; Lexington, KY; West Liberty, KY |
National Provider Directory
National Provider DirectoryLocations
138 E Reynolds Rd
Ste 101
Lexington, KY 40517
Phone (859) 273-2020
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1333843200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336003200000",
"number": "1780940361",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "138 E REYNOLDS RD",
"address_2": "101",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405171257",
"telephone_number": "859-273-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "138 E REYNOLDS RD",
"address_2": "101",
"city": "LEXINGTON",
"state": "KY",
"postal_code": "405171257",
"telephone_number": "859-273-2020"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ANGELA COSTA, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2012-04-08",
"last_updated": "2012-05-03",
"status": "A",
"authorized_official_last_name": "COSTA",
"authorized_official_first_name": "ANGELA",
"authorized_official_title_or_position": "CO-OWNER",
"authorized_official_telephone_number": "859-273-2020",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "KY",
"license": "1612DT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lexington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.