Jeffrey L Broadhead, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

4826018-9934 Issued in UT

Practice address

3556 W 9800 S
Suite 104
South Jordan, UT 84095-3211

Phone

(801) 253-6590

Fax

(801) 253-6591

NPI assigned

Nov 22, 2005

Last updated

Jun 23, 2015By the provider in NPPES

Sex

Male

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

Enrolled in UT

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, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Progressive Eye Care, LLCGroup PAC ID 5799718912, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO

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.

• Progressive Eye Care, LLC

  • Optometrist
  • South Jordan, UT
  • NPI 1922282599
  Medicare reassignment Care Compare group NPD Authorized official
• Progressive Eye Care, LLC

  dba Classic Optical

  • Optometrist
  • Murray, UT
  • NPI 1659917706
  NPD Authorized official
• Stromness Vision PC

  dba Canyon Eye Specialists

  • Optometrist
  • Sandy, UT
  • NPI 1396869947
  NPD (past)

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435017600000",
    "number": "1306829569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3556 W 9800 S",
            "address_2": "SUITE 104",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953211",
            "telephone_number": "801-253-6590",
            "fax_number": "801-253-6591"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3556 W 9800 S",
            "address_2": "SUITE 104",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840953211",
            "telephone_number": "801-253-6590",
            "fax_number": "801-253-6591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADHEAD",
        "first_name": "JEFFREY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2015-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "4826018-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jordan Briggs, CMHC
• Brighter Skies Services PLLC
• Brighton House Assisted Living LLC (Brighton House of South Jordan)
• Curtis Brimley, DMD, MS
• Kambrea Muhlestein Bringhurst
• Tamara Lynn Broadhead, APRN
• Jeremy John Bromley, RPH
• Aryssa Broome, RN
• Joshua Conover Brough, DPT
• Aniston Brown

• Optometrist in South Jordan, UT
• Providers in South Jordan, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2015; 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.