Tara Brackley, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

TUV008116 Issued in NY

Practice address

4000 Medical Center Dr
Suite 207
Fayetteville, NY 13066-6631

Phone

(315) 637-1010

Fax

(315) 637-2010

NPI assigned

Jun 11, 2014

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

Other identifiers 1

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: tarabrackley@direct-address.net

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.

• Eye Surgeons of Central New York, PC

  • Ophthalmology Physician
  • Liverpool, NY
  • NPI 1881725810

  NY, Optometrist

  Medicare reassignment Care Compare group NPD
• Empire Vision Center Inc

  • Optometrist
  • Syracuse, NY
  • NPI 1750358826

  NY, Optometrist

  Medicare reassignment NPD
• Empire Vision Center, Inc

  • Eyewear Supplier
  • Attleboro, MA
  • NPI 1730635582
  NPD
• Nancy L. Oplinger, MD Richard J. Freeman, MD

  • Ophthalmology Physician
  • Auburn, NY
  • NPI 1083818959
  NPD (past)
• Negrin MD PLLC

  • Specialist
  • New York, NY
  • NPI 1699204859
  NPD (past)

Specialty

Optometry

Education

New England College of Optometry, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Surgeons of Central New York, P.C. 4 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1144633702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6221 STATE ROUTE 31",
            "address_2": "SUITE 104",
            "city": "CICERO",
            "state": "NY",
            "postal_code": "130398715",
            "telephone_number": "315-752-0141",
            "fax_number": "315-752-0142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 MEDICAL CENTER DR",
            "address_2": "SUITE 207",
            "city": "FAYETTEVILLE",
            "state": "NY",
            "postal_code": "130666631",
            "telephone_number": "315-637-1010",
            "fax_number": "315-637-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKLEY",
        "first_name": "TARA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "TUV008116",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NYS LICENSE",
            "identifier": "TUV008116",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Biby Rajan-George M.D PLLC
• Allan M Birnbaum, MD
• Patricia Jean Boehlert
• Mary Beth Borio, DPT, MS, CERT MDT
• Jessica Faye Bouchard, RPA-C
• Carole S. Bragdon, MSW, LCSW
• Denis F Branson, MD
• Susan Hartman Brenizer, M.A., LMFT (LICENSED
• Erica L Brier-Kennedy, LMFT
• Mark Briggs, LCSW

• All providers in Fayetteville, NY
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; 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.