Active NPI
Brad Mitchell Genereux, O.D.
- Optometrist
- Blue Ash, OH
National Provider Identifier
1386080166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 6175
- Practice address
- 1945 Cei Dr
Blue Ash, OH 45242-5664 - Phone
- (513) 984-5133
- Fax
- (513) 569-3941
- NPI assigned
- May 20, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 6175 | OH | Primary |
Addresses
Primary practice location
1945 Cei Dr
Blue Ash, OH 45242-5664
Mailing address
1945 Cei Dr
Blue Ash, OH 45242-5664
Phone (513) 984-5133
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6175 | OH | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1369008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1369008000000",
"number": "1386080166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1945 CEI DR",
"city": "BLUE ASH",
"state": "OH",
"postal_code": "452425664",
"telephone_number": "513-984-5133",
"fax_number": "513-569-3941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1945 CEI DR",
"city": "BLUE ASH",
"state": "OH",
"postal_code": "452425664",
"telephone_number": "513-984-5133",
"fax_number": "513-569-3941"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GENEREUX",
"first_name": "BRAD",
"middle_name": "MITCHELL",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-05-20",
"last_updated": "2013-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "6175",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blue Ash, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.