Holly Raeann Koopman, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2017DT Issued in KY

Practice address

6812 Dixie Hwy
Louisville, KY 40258-3914

Phone

(502) 933-7986

Fax

(502) 933-2652

NPI assigned

Jun 15, 2016

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Enrolled in KY, IN2 enrollments

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 2

Specialty

Optometry

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Louisville Optometric Centers III, PSCGroup PAC ID 8729041926, 38 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Louisville Optometric Centers III, PSC

  dba Vision First

  • Optometrist
  • Louisville, KY
  • NPI 1134111271

  IN

  Medicare reassignment Care Compare group NPD
• Louisville Optometric Centers III, PSC

  dba VisionFirst

  • Eyewear Supplier
  • Louisville, KY
  • NPI 1538938725
  NPD
• Louisville Optometric Centers, III PSC

  dba VisionFirst

  • Optometrist
  • New Albany, IN
  • NPI 1821164740
  NPD (past)

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

{
    "created_epoch": "1465948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1851741425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 POPLAR LEVEL RD",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402131524",
            "telephone_number": "502-813-8928",
            "fax_number": "502-456-9121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6812 DIXIE HWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402583914",
            "telephone_number": "502-933-7986",
            "fax_number": "502-933-2652"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12911 Shelbyville Rd",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402431613",
            "country_code": "US",
            "telephone_number": "502-254-1100",
            "fax_number": "502-254-7634",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4326 Charlestown Rd # 2",
            "address_purpose": "LOCATION",
            "city": "New Albany",
            "state": "IN",
            "postal_code": "471508542",
            "country_code": "US",
            "telephone_number": "812-945-0023",
            "fax_number": "812-945-0291",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "285 N Hubbards Ln Ste 500",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402073217",
            "country_code": "US",
            "telephone_number": "502-454-9122",
            "fax_number": "502-456-9121",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOOPMAN",
        "first_name": "HOLLY",
        "middle_name": "RAEANN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-06-15",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004061A",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KY",
            "license": "2017DT",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY MEDICARE",
            "identifier": "K249890",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY LIENSE",
            "identifier": "2017DT",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA LICENSE NUMBER",
            "identifier": "18004061A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIANA MEDICARE",
            "identifier": "221390002",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KENTUCKY LICENSE NUMBER",
            "identifier": "2017DT",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100492340",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sara Elizabeth Konger, COTA
• Jesse Kooistra
• Kool Smiles, PSC (Ruby Dental)
• David Koonce, APRN
• William L Koontz, MD
• Hermine Joelle Kopala, RPH
• Dennis P Koper, M.D.
• Morgan Kopka, RDN, LD
• Kopp & Luckett Family Dentistry, PLLC
• Brian Matthew Kopp, D.M.D.

• Optometrist in Louisville, KY
• Providers in Louisville, KY by specialty
• Optometrist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 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.