Broecker Eye & Optical

Primary specialty

OptometristTaxonomy code 152W00000X

License

2108 Issued in MN

Legal business name

BROECKER EYE & OPTICAL

Practice address

2356 University Ave W
Suite 260
Saint Paul, MN 55114-1853

Phone

(651) 645-8124

Fax

(651) 645-8125

NPI assigned

Jun 19, 2006

Organization subpart

No

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

Authorized official

Name

Stacey T. Broecker, O.D.NPI 1922053040

Title

Optometrist

Phone

(651) 645-8124

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Locations

Practitioners 2

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

• Stacey T. Broecker, O.D.

  • Optometrist
  • Saint Paul, MN
  • NPI 1922053040
  Medicare reassignment NPD Authorized official
• Kristin R. Swenson, O.D.

  • Optometrist
  • Saint Paul, MN
  • NPI 1770656845
  NPD (past)

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1114962529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2356 UNIVERSITY AVE W",
            "address_2": "SUITE 260",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141853",
            "telephone_number": "651-645-8124",
            "fax_number": "651-645-8125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2356 UNIVERSITY AVE W",
            "address_2": "SUITE 260",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551141853",
            "telephone_number": "651-645-8124",
            "fax_number": "651-645-8125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROECKER EYE & OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BROECKER",
        "authorized_official_first_name": "STACEY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "651-645-8124",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Vonne Brodersen, DDS
• Jane S Brodie, PHD
• Peter Samuel Brodrick, MD
• Andrea Brody, PA-C
• Richard Jay Brody, M.D.
• Stacey T. Broecker, O.D.
• Michael Brogan
• Shelly Brogni, R.D., L.D.
• Natarah B Broich, PA-C
• William A Brombach, MD

• Optometrist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.