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

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1684	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	551764	OTHER		NATIONAL VISION ADMIN.
2	6151	OTHER	IA	MIDLANDS CHOICE
3	9391471	OTHER		PRIVATE HEALTH CARE SYSTE
4	36759	OTHER	IA	BLUE CROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740279470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK L. BOTTELSON, O.D. AND ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	1001 73RD ST
Second Line	:	VISION CENTER
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1311
Country	:	US
Telephone Number	:	515-274-6452
Fax Number	:	515-274-6306

Provider Business Practice Location Address
First Line	:	1001 73RD ST
Second Line	:	VISION CENTER
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-1311
Country	:	US
Telephone Number	:	515-274-6452
Fax Number	:	515-274-6306

Authorized Official
Title or Position	:	INSURANCE MANAGER
Name	:	MRS. ELAINE RAHE BOTTELSON
Credential	:
Telephone Number	:	515-274-6452

Provider Enumeration Date	:	10/15/2005
Last Update Date	:	07/13/2009

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