Medicaid Provider Spending

$1.09 trillion in Medicaid claims data, 2018–2024 · 617K+ providers
Home › IL › CALUMET CITY › FOR EYES OPTICAL OF PA

FOR EYES OPTICAL OF PA

NPI: 1053469601 · CALUMET CITY, IL 60409 · Eyewear Supplier · NPI assigned 01/08/2007

Deactivated NPI · This NPI was deactivated on 07/11/2013. Reactivated 08/02/2013.
$5K
Total Medicaid Paid
282
Total Claims
278
Beneficiaries
5
Codes Billed
2018-01
First Month
2019-06
Last Month

Provider Details

Authorized OfficialCOSTA, JOSE (CEO)
NPI Enumeration Date01/08/2007

Related Entities

Other providers sharing the same authorized official: COSTA, JOSE

ProviderCityStateTotal Paid
FOR EYES OPTICAL OF PUERTO RICO, LLC MAYAGUEZ PR $4K

Monthly Spending Trend

Yearly Breakdown

YearClaimsTotal Paid
2018 104 $2K
2019 178 $3K

Billing Codes

CodeDescriptionClaimsBeneficiariesTotal Paid
V2100 Sphere, single vision, plano to plus or minus 4.00, per lens 93 90 $2K
V2020 Frames, purchases 105 105 $1K
92340 Fitting of spectacles, except for aphakia; monofocal 51 50 $710.00
V2103 Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens 16 16 $487.50
V2025 Deluxe frame 17 17 $0.00