Active NPI
Advanced Eye Care, PLLC
- Optometrist
- Roland, OK
National Provider Identifier
1154655280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2597
- Legal business name
- ADVANCED EYE CARE, PLLC
- Practice address
- 311 E Ray Fine Blvd
Suite 5
Roland, OK 74954-5160 - Phone
- (918) 427-3937
- Fax
- (918) 427-8882
- NPI assigned
- Sep 22, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Kimberley Ann Brunk, O.D.
- Title
- Owner
- Phone
- (918) 427-3937
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2597 | OK | Primary |
Addresses
Primary practice location
311 E Ray Fine Blvd
Suite 5
Roland, OK 74954-5160
Mailing address
PO Box 1075
Roland, OK 74954-1075
Phone (918) 427-3937
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091009000232 | OK | Part B Supplier - Clinic/Group Practice | 7517003262 |
Receives reassigned benefits from 2 practitioners Practice locations: Roland, OK |
National Provider Directory
National Provider DirectoryLocations
311 E Ray Fine Blvd
Ste 5
Roland, OK 74954
Phone (918) 427-3937
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Van Buren, AR
- NPI 1578753364
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1253577600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1282089600000",
"number": "1154655280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1075",
"city": "ROLAND",
"state": "OK",
"postal_code": "749541075",
"telephone_number": "918-427-3937",
"fax_number": "918-427-8882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "311 E RAY FINE BLVD",
"address_2": "SUITE 5",
"city": "ROLAND",
"state": "OK",
"postal_code": "749545160",
"telephone_number": "918-427-3937",
"fax_number": "918-427-8882"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "ADVANCED EYE CARE, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2009-09-22",
"last_updated": "2010-08-18",
"status": "A",
"authorized_official_last_name": "BRUNK",
"authorized_official_first_name": "KIMBERLEY",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "918-427-3937",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "OK",
"license": "2597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roland, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.