NPIMap

Organization Active NPI

R. Scott Oberbreckling, O.D. LLC

  • Optometrist
  • Boulder, CO
National Provider Identifier
1033204136
Registry record updated Jul 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CO1975 Issued in CO
Legal business name
R. SCOTT OBERBRECKLING, O.D. LLC
Practice address
2648 Broadway St
Boulder, CO 80304-3542
Phone
(303) 938-8646
Fax
(303) 938-4087
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2009

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

Authorized official

Name
Robert Scott Oberbreckling, ODNPI 1053404509
Title
Owner
Phone
(303) 938-8646

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X CO1975 CO Primary

Addresses

Primary practice location

2648 Broadway St
Boulder, CO 80304-3542

Mailing address

2648 Broadway St
Boulder, CO 80304-3542
Phone (303) 938-8646

Other names 1

  • Broadway Eye & Vision Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

2648 Broadway St
Boulder, CO 80304
Phone (303) 938-8646

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248393600000",
    "number": "1033204136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2648 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043542",
            "telephone_number": "303-938-8646",
            "fax_number": "303-938-4087"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2648 BROADWAY ST",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803043542",
            "telephone_number": "303-938-8646",
            "fax_number": "303-938-4087"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "R. SCOTT OBERBRECKLING, O.D. LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-07-24",
        "status": "A",
        "authorized_official_last_name": "OBERBRECKLING",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-938-8646",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CO",
            "license": "CO1975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Eye & Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boulder, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.