Bradley James Runyon, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901004130 Issued in MI

Practice address

830 W Michigan Ave
Marshall, MI 49068-1446

Phone

(269) 781-9822

Fax

(269) 781-9839

NPI assigned

Feb 12, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Gossage Eye Institute, PLCGroup PAC ID 3779473228, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gossage Eye Institute, PLC

  • Ophthalmology Physician
  • Hillsdale, MI
  • NPI 1285854000
  Medicare reassignment Care Compare group NPD
• Great Lakes Plastic Reconstructive & Hand Surgery P C

  • Plastic Surgery Physician
  • Portage, MI
  • NPI 1336335785
  NPD (past)

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

{
    "created_epoch": "1234396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447891200000",
    "number": "1013156124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "830 W MICHIGAN AVE",
            "city": "MARSHALL",
            "state": "MI",
            "postal_code": "490681446",
            "telephone_number": "269-781-9822",
            "fax_number": "269-781-9839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 W MICHIGAN AVE",
            "city": "MARSHALL",
            "state": "MI",
            "postal_code": "490681446",
            "telephone_number": "269-781-9822",
            "fax_number": "269-781-9839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNYON",
        "first_name": "BRADLEY",
        "middle_name": "JAMES",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-02-12",
        "last_updated": "2015-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901004130",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013156124",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Louise Robin, DPM
• Erin Rockwell, D.O.
• Katherine Rogers, PTA
• Jonathan Michael Ross, M.D.
• Lauri Rowe
• Rachel Saeger, FNP
• Mahboobeh Saifiabolhassan
• Tarek Saleh, M.D
• Wisam A Salman, MD
• Logan Saxton, PHARMD

• Optometrist in Marshall, MI
• Providers in Marshall, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.