NPIMap

Organization Active NPI

Midwest Eye Associates, Inc.

  • Optometrist
  • Saint Charles, MO
National Provider Identifier
1215159504
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MIDWEST EYE ASSOCIATES, INC.
Practice address
1384 S 5TH St
Saint Charles, MO 63301-2444
Phone
(636) 946-9242
Fax
(636) 946-4903
NPI assigned
May 3, 2007
Last updated
Apr 15, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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

Authorized official

Name
Bradley A Byergo, ODNPI 1336272285
Title
OD/Owner
Phone
(508) 837-3790

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)CodeLicenseStatePrimary
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

1384 S 5TH St
Saint Charles, MO 63301-2444

Mailing address

1384 S 5TH St
Saint Charles, MO 63301-2444
Phone (636) 946-9242

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081023000572 MO Part B Supplier - Clinic/Group Practice 3870651508 Receives reassigned benefits from 9 practitioners
Practice locations: Creve Coeur, MO; Saint Charles, MO; Saint Peters, MO; Wentzville, MO

National Provider Directory

National Provider Directory

Locations

13025 Olive Blvd
Creve Coeur, MO 63141
Phone (314) 878-8770

1384 S 5th St
Saint Charles, MO 63301
Phone (636) 946-9242

12392 Olive Blvd
Saint Louis, MO 63141
Phone (314) 878-8770

1401 Triad Center Dr
Saint Peters, MO 63376
Phone (636) 441-8010

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586908800000",
    "number": "1215159504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1384 S 5TH ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012444",
            "telephone_number": "636-946-9242",
            "fax_number": "636-946-4903"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1384 S 5TH ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633012444",
            "telephone_number": "636-946-9242",
            "fax_number": "636-946-4903"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST EYE ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A",
        "authorized_official_last_name": "BYERGO",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OD/OWNER",
        "authorized_official_telephone_number": "508-837-3790",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.

Verify at the official NPI Registry.