NPIMap

Organization Active NPI

Dennis M Brtva

  • Optometrist
  • Peoria, IL
National Provider Identifier
1336112804
Registry record updated Jan 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
DENNIS M BRTVA
Practice address
801 W Lake Ave
300 Evergreen Square
Peoria, IL 61614-5951
Phone
(309) 686-0763
Fax
(309) 685-8809
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2008

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

Authorized official

Name
Dr. Dennis M Brtva, O.D.NPI 1215909056
Title
Owner
Phone
(309) 663-2211

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X IL Primary

Addresses

Primary practice location

801 W Lake Ave
300 Evergreen Square
Peoria, IL 61614-5951

Mailing address

801 W Lake Ave
300 Evergreen Square
Peoria, IL 61614-5951
Phone (309) 686-0763

Other identifiers 1

IdentifierTypeStateIssuer
7221381OtherILBLUE CROSS/BLUE SHIELD

Other names 1

  • Dr Dennis M Brtva & Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dennis M Brtva2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2109 N Veterans Pkwy
Bloomington, IL 61704
Phone (309) 663-2020

4203 N Sheridan Rd
Ste 14
Peoria, IL 61614

801 W Lake Ave
#300
Peoria, IL 61614
Phone (309) 685-9800

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199232000000",
    "number": "1336112804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 W LAKE AVE",
            "address_2": "300 EVERGREEN SQUARE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145951",
            "telephone_number": "309-686-0763",
            "fax_number": "309-685-8809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W LAKE AVE",
            "address_2": "300 EVERGREEN SQUARE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145951",
            "telephone_number": "309-686-0763",
            "fax_number": "309-685-8809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DENNIS M BRTVA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2008-01-02",
        "status": "A",
        "authorized_official_last_name": "BRTVA",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-663-2211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "7221381",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr Dennis M Brtva & Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2008; 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.