David Thomas Brockbank, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

6540468-1205 Issued in UT

Practice address

1055 N 500 W Ste 201
Provo, UT 84604-3305

Phone

(801) 375-6565

Fax

(801) 373-9750

NPI assigned

Aug 23, 2006

Last updated

Feb 25, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Interoperability endpoints

• Direct secure messaging: davidbrockbank@cuccu.allscriptsdirect.net

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

• Olympus Eye Associates, PC

  • Ophthalmology Physician
  • Murray, UT
  • NPI 1912202425
  Medicare reassignment NPD
• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Provo, UT
  • NPI 1093764805
  Medicare reassignment NPD
• Revere Health PC

  dba Revere Health

  • Multi-Specialty Clinic/Center
  • Spanish Fork, UT
  • NPI 1851142285
  NPD

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771977600000",
    "number": "1093822561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1055 N 500 W",
            "address_2": "ATTN: CREDENTIALING",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-354-8225",
            "fax_number": "801-418-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N 500 W STE 201",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043305",
            "telephone_number": "801-375-6565",
            "fax_number": "801-373-9750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6065 Fashion Blvd",
            "address_2": "Ste 125",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841077381",
            "country_code": "US",
            "telephone_number": "801-261-0726",
            "fax_number": "801-262-2838",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5872 S 900 E Ste 100",
            "address_purpose": "LOCATION",
            "city": "Murray",
            "state": "UT",
            "postal_code": "841211677",
            "country_code": "US",
            "telephone_number": "801-261-0726",
            "fax_number": "801-262-2838",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROCKBANK",
        "first_name": "DAVID",
        "middle_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-23",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "UT",
            "license": "6540468-1205",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "T2003013455",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cassie K Broadhead, PA-C
• Jeffrey Charles Broberg, M.D.
• Kathryn Larue Broberg
• David Wesley Brock, PA-C
• Disa T. Brock
• Luke McKell Brockbank, MD
• Clara Susanne Broderick, SSW
• Summer Alyse Broeker
• Raisa Brandao Brogan
• Barbara Jean Bronson, LCSW

• Ophthalmology Physician in Provo, UT
• Providers in Provo, UT by specialty
• Ophthalmology Physician in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.