Ronald Brackenbury, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

18002344A Issued in IN

Practice address

1700 E 38TH St
Marion, IN 46953-4568

Phone

(765) 674-3321

NPI assigned

Aug 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336156561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723 W EUCLID AVE",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469523456",
            "telephone_number": "765-664-3224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 E 38TH ST",
            "city": "MARION",
            "state": "IN",
            "postal_code": "469534568",
            "telephone_number": "765-674-3321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACKENBURY",
        "first_name": "RONALD",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002344A",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keith Thomas Bowen, RPH.
• Kathryn Anne Bowers, PHARMD
• Kymber L Bowman, LMFT-PENDING
• Samantha L Bowser, MA
• Carole Brace, M.A., R.N.
• Bradford G Bichey, M.D. LLC
• Jacob Bradford, LMHC-A
• Jailyn Bradley
• Heather D Brady, FNP-C
• Robin Brady, SLP

• Optometrist in Marion, IN
• Providers in Marion, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.