Broadway Vision Associates, PLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BROADWAY VISION ASSOCIATES, PLC

Practice address

435 W Broadway St
Muskogee, OK 74401-6614

Phone

(918) 687-4459

Fax

(918) 687-0238

NPI assigned

Mar 29, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Candace Y. Stewart, ODNPI 1588633697

Title

OD Owner

Phone

(918) 687-4459

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OK2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 2

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

• Candace Yolande Stewart, OD

  • Optometrist
  • Muskogee, OK
  • NPI 1588633697
  Medicare reassignment Care Compare group NPD Authorized official
• Leslie Rene Trimble, OD

  • Optometrist
  • Muskogee, OK
  • NPI 1992773345
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266451200000",
    "number": "1154441848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 W BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744016614",
            "telephone_number": "918-687-4459",
            "fax_number": "918-687-0238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "435 W BROADWAY ST",
            "city": "MUSKOGEE",
            "state": "OK",
            "postal_code": "744016614",
            "telephone_number": "918-687-4459",
            "fax_number": "918-687-0238"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY VISION ASSOCIATES, PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2010-02-18",
        "status": "A",
        "authorized_official_last_name": "STEWART",
        "authorized_official_first_name": "CANDACE",
        "authorized_official_middle_name": "Y.",
        "authorized_official_title_or_position": "OD OWNER",
        "authorized_official_telephone_number": "918-687-4459",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100739020A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cassandra Brillhart-Green, FNP-C
• Felicia Lauren Brittle
• Dawn Melody Brizendine
• Broadway Healthcare, LLC
• Broadway Manor Management L.L.C (Broadway Manor Nursing Home)
• William Nelson Brock
• Scarlet Bronson
• Joshua Warren Brooks
• Lavette Brooks, RN
• Devan T. Brotherton, M.S. L.P.C.

• Optometrist in Muskogee, OK
• Providers in Muskogee, OK by specialty
• Optometrist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.