Mackenzie Anne Bradley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV009204-01 Issued in NY

Practice address

33 W 42ND St
New York, NY 10036-8005

Phone

(212) 938-4001

NPI assigned

May 11, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

State University of New York - State College Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evergreen Optometry PLLCGroup PAC ID 0042745135, 2 clinicians

Eye Care Vision Optometry PCGroup PAC ID 2365848165, 32 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Evergreen Optometry PLLC

  • Optometrist
  • Hamburg, NY
  • NPI 1710731104
  Medicare reassignment Care Compare group NPD Authorized official
• Eye Care Vision Optometry P.C.

  • Optometrist
  • Staten Island, NY
  • NPI 1851983654
  Medicare reassignment Care Compare group NPD
• Eye Care Professionals of Western New York, LLP

  • Optometrist
  • Depew, NY
  • NPI 1619194115
  Medicare reassignment NPD
• State of New York Comptrollers Office

  • Optometrist
  • New York, NY
  • NPI 1407829856
  Medicare reassignment NPD
• Eye Care Professionals of Western New York LLP

  • Optometrist
  • Williamsville, NY
  • NPI 1780235663
  NPD
• State of New York Comptrollers Office

  • Developmental Disabilities Clinic/Center
  • Staten Island, NY
  • NPI 1750469912
  NPD

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

{
    "created_epoch": "1589155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596672000000",
    "number": "1124640305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 GORDON AVE",
            "city": "BRIARCLIFF MANOR",
            "state": "NY",
            "postal_code": "105101509",
            "telephone_number": "973-897-9715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 W 42ND ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100368005",
            "telephone_number": "212-938-4001"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "760 Broadway # 2B-330",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112065317",
            "country_code": "US",
            "telephone_number": "718-963-8000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MACKENZIE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-11",
        "last_updated": "2020-08-06",
        "certification_date": "2020-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV009204-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph Thomas Bradley, STUDENT
• Katrina Suzanne Bradley, MD
• Lauren Bradley
• Lauren Nicole Bradley, LMSW, LSW
• Linda Joyce Bradley, CSW
• Margaret Bradley, PT OCS
• Mark Vincent Bradley, M.D.
• Shannon Poplin Bradley, LCAT, ATR-BC
• Sheila Conway Bradley, NURSE PRACTITIONER
• Susan R Bradley, D.C.

• Optometrist in New York, NY
• Providers in New York, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2020; 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.