Bradley P Bangstad, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC 1898 Issued in FL

Practice address

4220 NW 16TH Blvd
Gainesville, FL 32605-3508

Phone

(352) 331-5440

Fax

(352) 271-3353

NPI assigned

Jul 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Brad Bangstad Professional name

Medicare fee-for-service enrollment

Enrolled in FL

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

Ohio State University - College of Optometry, 1983

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

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  NPD (past)
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  • NPI 1639325434
  NPD (past)
• Tiffany Monahan, O.D. LLC

  • Optometrist
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  • NPI 1720160096
  NPD (past)

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1419811200000",
    "number": "1013935006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4220 NW 16TH BLVD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326053508",
            "telephone_number": "352-331-5440",
            "fax_number": "352-271-3353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4220 NW 16TH BLVD",
            "city": "GAINESVILLE",
            "state": "FL",
            "postal_code": "326053508",
            "telephone_number": "352-331-5440",
            "fax_number": "352-271-3353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANGSTAD",
        "first_name": "BRADLEY",
        "middle_name": "P",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2014-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 1898",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "621121600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BRAD",
            "last_name": "BANGSTAD",
            "credential": "O.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Elizabeth Bamiro
• Genevieve Banaag
• Abdulaziz Banasser, BDS
• Gary Wayne Banfield, D,D,S,
• Grant Patrick Banfill
• Lesley Chuc Banh
• Wanda Banhan, PA-C
• Mo'Ath Issam Abdellatif Bani Salem, M.D
• Lashauna Latia Banks-Chatman
• Gavin Banks-Hill

• Optometrist in Gainesville, FL
• Providers in Gainesville, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2014; 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.