Individual provider Active NPI

Bayley Marie Brunck, OD

  • Optometrist
  • Bloomington, IN
National Provider Identifier
1013569243
Registry record updated Oct 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18004177A Issued in IN
Practice address
1105 S College Mall Rd
Bloomington, IN 47401-6177
Phone
(812) 333-2020
Fax
(812) 334-2020
NPI assigned
Jul 9, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 28, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 18004177A IN Primary

Addresses

Primary practice location

1105 S College Mall Rd
Bloomington, IN 47401-6177

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
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

Enrollment IDStateProvider typePAC IDDetails
I20200728000150 IN Practitioner - Optometry 8921422635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Indiana LLCGroup PAC ID 5496091316, 82 clinicians

Practice addresses (Care Compare)

1105 S College Mall Rd
Bloomington, IN 47401-6177
Phone (812) 333-2020

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18004177AINMDOptometrist

Practice roles (3 of 5)

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Jul 15, 2020 Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist CurrentSince Jul 15, 2020 Accepting new patients
Myeyedr Optometry of Indiana, LLC Optometrist Current Accepting new patients

Locations

1105 S College Mall Rd
Bloomington, IN 47401
Phone (812) 333-2020

9760 Lantern Rd
Fishers, IN 46037
Phone (317) 577-9200

357 W Morgan St
Ste C
Spencer, IN 47460
Phone (812) 829-1254

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Networks

  • KY PPO
  • KY PPO C-SNP

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1562630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635379200000",
    "number": "1013569243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 S COLLEGE MALL RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474016177",
            "telephone_number": "812-333-2020",
            "fax_number": "812-334-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNCK",
        "first_name": "BAYLEY",
        "middle_name": "MARIE",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-07-09",
        "last_updated": "2021-10-28",
        "certification_date": "2021-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18004177A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

Verify at the official NPI Registry.