Individual provider Active NPI

Katrina Ann Kotcho

  • Optometrist
  • Allentown, PA
National Provider Identifier
1891310603
Registry record updated Jul 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG003690 Issued in PA
Practice address
3110 Hamilton Blvd
Allentown, PA 18103-3630
Phone
(610) 776-4304
NPI assigned
Jun 8, 2020
Last updated
Jul 1, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 1, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Optometrist 152W00000X OEG003690 PA Primary

Addresses

Primary practice location

3110 Hamilton Blvd
Allentown, PA 18103-3630

Mailing address

518 Lackawanna St
Jermyn, PA 18433-1215
Phone (570) 335-5714

Other practice location 1

1111 E End Blvd
Wilkes Barre, PA 18711-0030
Phone (570) 824-3521

Other practice location 2

240 Main St
Peckville, PA 18452-2438
Phone (570) 489-8733

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210415000466 PA Practitioner - Optometry 7719395581 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG003690PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Schoonover Eye Care, P.C. Optometrist CurrentSince May 1, 2021 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1591574400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625097600000",
    "number": "1891310603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 LACKAWANNA ST",
            "city": "JERMYN",
            "state": "PA",
            "postal_code": "184331215",
            "telephone_number": "570-335-5714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3110 HAMILTON BLVD",
            "city": "ALLENTOWN",
            "state": "PA",
            "postal_code": "181033630",
            "telephone_number": "610-776-4304"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 E End Blvd",
            "address_purpose": "LOCATION",
            "city": "Wilkes Barre",
            "state": "PA",
            "postal_code": "187110030",
            "country_code": "US",
            "telephone_number": "570-824-3521",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "240 Main St",
            "address_purpose": "LOCATION",
            "city": "Peckville",
            "state": "PA",
            "postal_code": "184522438",
            "country_code": "US",
            "telephone_number": "570-489-8733",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOTCHO",
        "first_name": "KATRINA",
        "middle_name": "ANN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-08",
        "last_updated": "2021-07-01",
        "certification_date": "2021-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003690",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Allentown, PA

Sources for this page

Verify at the official NPI Registry.