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DR. KEVIN MARK ELLSWORTH O.D.
NPI 1669457024
Optometrist in Logan, UT

Active since December 08, 2005PECOS EnrolledAccepts Medicare Assignment
395 E 1400 N, SUITE B, LOGAN, UT 84341(435) 752-5585(435) 787-2871 Get Directions Write a Review

NPPES record last updated: August 20, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Dr. Kevin Mark Ellsworth O.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KEVIN MARK ELLSWORTH O.D. (NPI 1669457024) is an individual optometrist in Logan, Utah, licensed in Utah (112376-9934) and active in the NPI registry since December 2005. He is enrolled in Medicare PECOS and is a graduate of Southern California College Of Optometry (1985).

NPPES Registry Identity

NPI1669457024
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. KEVIN MARK ELLSWORTHCredential: O.D.
Location Address395 E 1400 N, SUITE BLogan, UT 84341-7573
Mailing Address395 E 1400 N, Suite BLogan, UT 84341-7573 · (435) 752-5585 · Fax (435) 787-2871
Phone(435) 752-5585
Fax(435) 787-2871
Sole ProprietorYes
Medical School CMSSouthern California College Of OptometryGraduated 1985
Enumeration DateDecember 8, 2005
Last NPPES UpdateAugust 20, 2008
✔ NPI 1669457024 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in UT · 112376-9934
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
395 E 1400 N, Logan, UT 84341
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Other Identifiers 2

Medicare UPINT78174UT
Medicare PIN000009827UT

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Molina Healthcare, Providence Health Plan and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kevin Mark Ellsworth O.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5890775027
PECOS Enrollment IDI20040720001186
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Photography of the retina 92250
Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
113 services112 patients
Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
86 services85 patients
New patient complete exam of visual system 92004
A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
26 services26 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 84341 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$125.70 typical visit price
range $54.34 – $166.03
Typical copayment $31.42 (range $13.58 – $41.50)
Most-billed visit code 99204
Established Patient
$68.01 typical visit price
range $17.23 – $135.20
Typical copayment $17.00 (range $4.30 – $33.80)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kevin Ellsworth's NPI number?

The NPI number for Kevin Ellsworth is 1669457024. It was assigned to this individual provider in the NPPES registry on December 8, 2005.

Where is Kevin Ellsworth located?

Kevin Ellsworth practices at 395 E 1400 N Suite B, Logan, UT 84341. The listed phone number is (435) 752-5585.

What is Kevin Ellsworth's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Kevin Ellsworth enrolled in Medicare?

Yes. Kevin Ellsworth is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kevin Ellsworth accept?

Health plans from BridgeSpan Health Company, Molina Healthcare, Providence Health Plan, Regence BlueCross BlueShield of Utah and Select Health and 1 other insurer list Kevin Ellsworth as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kevin Ellsworth was last updated on August 20, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.