Philip M Brock, OD
Individual provider Active NPI Optometrist · Crossville, TN
NPI 1043078611 · NPPES record last updated Jun 25, 2024
Key facts
- NPI
- 1043078611
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 3881 (TN)
- Practice address
- 15 Iris LN
Crossville, TN 38555-7528 - Phone
- (931) 456-2728
- Fax
- (931) 456-5446
- NPI assigned
- Mar 8, 2024
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 9
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eye Centers of Tennessee, LLC
Practice addresses (Care Compare)
15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240624001286 | TN | Practitioner - Optometry | 6002359627 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Centers of Tennessee, LLC | Optometrist | Current |
Accepting new patients |
| Eye Centers of Tennessee, LLC | Optometrist | Current |
Accepting new patients |
Locations
15 Iris Ln
Crossville, TN 38555
Phone (931) 456-2728
3302 Main St
Pikeville, TN 37367
Phone (423) 556-0808
305 N Spring St
Sparta, TN 38583
Phone (931) 836-2424
Interoperability endpoints
- pbrock@ecotn.intellechartdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | 3881 | TN | Yes |
Addresses
Primary practice location
15 Iris LN
Crossville, TN 38555-7528
Mailing address
15 Iris LN
Crossville, TN 38555-7528
Phone (931) 456-2728
Other providers in Crossville, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 25, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.