Lee Theodore Bottem, DO is a medicare enrolled "Ophthalmology" physician in Broken Arrow, Oklahoma. His current practice location is
4700 W Urbana St, Broken Arrow, Oklahoma. You can reach out to his office (for appointments etc.) via phone at
(918) 290-2300.
Lee Theodore Bottem is licensed to practice in Oklahoma (license number 4175) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1679745418.
Physician's Profile
| Full Name | Lee Theodore Bottem |
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| Gender | Male |
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| Speciality | Ophthalmology |
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| Location | 4700 W Urbana St, Broken Arrow, Oklahoma |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1679745418
- Provider Enumeration Date: 04/01/2008
- Last Update Date: 09/06/2019
Medicare PECOS Information:
- PECOS PAC ID: 5991754699
- Enrollment ID: I20050310000653
Medical Identifiers
Medical identifiers for Lee Theodore Bottem such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1679745418 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207W00000X | Ophthalmology | 4175 (Oklahoma) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lee Theodore Bottem allows following entities to bill medicare on his behalf.
| Entity Name | Lee Bottem, D.o., Plc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1104157296
PECOS PAC ID: 8325173834
Enrollment ID: O20100430000708 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lee Theodore Bottem is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Lee Theodore Bottem, DO
4700 W Urbana St,
Broken Arrow, OK 74012-5997
Ph: (918) 290-2300 | Lee Theodore Bottem, DO
4700 W Urbana St,
Broken Arrow, OK 74012-5997
Ph: (918) 290-2300 |
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