Lee Brock Wren, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP-100148 Issued in ID

Practice address

715 W Judicial St
Blackfoot, ID 83221-2036

Phone

(208) 785-2210

Fax

(208) 785-2216

NPI assigned

Aug 20, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in ID

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

Pacific University - College of Optometry, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Bingham Family Vision, LLC

  • Optometrist
  • Blackfoot, ID
  • NPI 1336624030
  Medicare reassignment NPD
• Standard Optical Co

  • Optometrist
  • Murray, UT
  • NPI 1508967977
  NPD (past)
• Standard Optical Company

  • Optometrist
  • West Point, UT
  • NPI 1659958841
  NPD (past)

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

{
    "created_epoch": "1187568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568073600000",
    "number": "1215120696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 W JUDICIAL ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212036",
            "telephone_number": "208-785-2210",
            "fax_number": "208-785-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 W JUDICIAL ST",
            "city": "BLACKFOOT",
            "state": "ID",
            "postal_code": "832212036",
            "telephone_number": "208-785-2210",
            "fax_number": "208-785-2216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WREN",
        "first_name": "LEE",
        "middle_name": "BROCK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-20",
        "last_updated": "2019-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "66612099934",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP-100148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1215120696",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "66612099900001",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "999000797009",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Meghan L Woolstenhulme
• Jared Worthington, DDS
• Wray Dermatology
• Adam Wray, DO
• Amanda Wray, RPH
• Shawn A Wren, CRNA
• Barbara Pancoast Young, LCSW
• Sandee K Young, LCSW
• Aimee Y Zhang, MD

• Optometrist in Blackfoot, ID
• Providers in Blackfoot, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2019; 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.