Nicole M Broadwell

Primary specialty

OpticianTaxonomy code 156FX1800X

Practice address

3018 East Ave
Central Square, NY 13036-2713

Phone

(315) 668-0422

NPI assigned

Sep 19, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1726704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1235966458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3018 EAST AVE",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130362713",
            "telephone_number": "315-668-0422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3018 EAST AVE",
            "city": "CENTRAL SQUARE",
            "state": "NY",
            "postal_code": "130362713",
            "telephone_number": "315-668-0422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADWELL",
        "first_name": "NICOLE",
        "middle_name": "M",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-19",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Leslee Boissy-Weatherup, DDS
• Debbie J Boland, LPN
• Kerstin L Bourgeois, LPN
• Theodore Boyle, DPT
• Bridget a Frio OD PC
• Allison Amy Bronner
• Rita Marie Burton, LPN
• Olessia Xenia Butenko, OD
• Central Square Central School District
• Central Square Dental Associates

• All providers in Central Square, NY
• Optician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.