Kimberley Ann Brunk, O.D.
Individual provider Active NPI Optometrist · Roland, OK
NPI 1316178155 · NPPES record last updated Jul 28, 2009
Key facts
- NPI
- 1316178155
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 2597 (OK)
- Practice address
- 1022 East Ray Fine Boulevard Suite 5
Roland, OK 74954 - Phone
- (918) 427-3937
- NPI assigned
- Jul 28, 2009
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Other, 2009
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advanced Eye Care, PLLC
Practice addresses (Care Compare)
311 E Ray Fine Blvd
Suite 5
Roland, OK 74954-5367
Phone (918) 427-3937
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20091014000512 | OK | Practitioner - Optometry | 5496891988 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Eye Care, PLLC | Optometrist | Current |
Accepting new patients |
Locations
311 E Ray Fine Blvd
Ste 5
Roland, OK 74954
Phone (918) 427-3937
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2597 | OK | Yes |
Addresses
Primary practice location
1022 East Ray Fine Boulevard Suite 5
Roland, OK 74954
Mailing address
1022 East Ray Fine Boulevard Suite 5
Roland, OK 74954
Phone (918) 427-3937
Other providers in Roland, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 28, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.