Individual provider Active NPI

Bradley D Martinson, OD

  • Optometrist
  • Godfrey, IL
National Provider Identifier
1174774079
Registry record updated Apr 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
046010101 Issued in IL
Practice address
3300 Godfrey Rd
Godfrey, IL 62035
Phone
(618) 466-8787
Fax
(618) 466-4703
NPI assigned
Oct 9, 2008
Last updated
Apr 25, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 25, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 046010101 IL Primary

Addresses

Primary practice location

3300 Godfrey Rd
Godfrey, IL 62035

Mailing address

PO Box 5040
Godfrey, IL 62035
Phone (618) 466-8787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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

Enrollment IDStateProvider typePAC IDDetails
I20081208000391 IL Practitioner - Optometry 5193886273 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rose Optical, Inc.Group PAC ID 2961586805, 4 clinicians

Practice addresses (Care Compare)

3300 Godfrey Rd
Godfrey, IL 62035-2558
Phone (618) 466-8787

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Rose Optical, Inc. Optometrist CurrentSince Dec 1, 2008 Accepting new patients
Illini Optometric PC Optometrist CurrentSince Jun 1, 2011 Accepting new patients

Locations

3300 Godfrey Rd
Godfrey, IL 62035
Phone (618) 466-8787

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1223510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303689600000",
    "number": "1174774079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5040",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "62035",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "62035",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARTINSON",
        "first_name": "BRADLEY",
        "middle_name": "D",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-09",
        "last_updated": "2011-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046010101",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Godfrey, IL

Sources for this page

Verify at the official NPI Registry.