Michael D Van Brocklin, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00001307 Issued in WA

Practice address

4330 Mitchell Way
Bellingham, WA 98226-9175

Phone

(360) 738-6860

Fax

(360) 738-6853

NPI assigned

Jun 18, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WA, AK2 enrollments

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 2

Specialty

Optometry

Education

Pacific University - College of Optometry, 1979

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Pacific Cataract and Laser Institute Inc PCGroup PAC ID 7517864119, 75 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michael.vanbrocklin.p1@direct.pcli.nextgenshare.com

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.

• Pacific Cataract and Laser Institute Inc PC

  • Ambulatory Surgical Clinic/Center
  • Bellevue, WA
  • NPI 1306013925
  Medicare reassignment Care Compare group NPD
• Pacific Cataract and Laser Institute of Alaska Inc PC

  • Ambulatory Surgical Clinic/Center
  • Anchorage, AK
  • NPI 1548213077
  Medicare reassignment NPD
• Pacific Cataract and Laser Institute Inc PC

  • Ambulatory Surgical Clinic/Center
  • Chehalis, WA
  • NPI 1487821633
  NPD
• Pacific Cataract and Laser Institute Inc PC

  • Ambulatory Surgical Clinic/Center
  • Vancouver, WA
  • NPI 1659548329
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ophthalmologic Surgery Clinic/Center
  • Auburn, WA
  • NPI 1528814647
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Silverdale, WA
  • NPI 1558538231
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Kennewick, WA
  • NPI 1619144607
  NPD
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Chehalis, WA
  • NPI 1114978848
  NPD (past)
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Lacey, WA
  • NPI 1215178835
  NPD (past)
• Pacific Cataract and Laser Institute, Inc., P.C.

  • Ambulatory Surgical Clinic/Center
  • Lewiston, ID
  • NPI 1780851691
  NPD (past)

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

{
    "created_epoch": "1150588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605744000000",
    "number": "1417992900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1506",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985320409",
            "telephone_number": "360-242-3008",
            "fax_number": "360-807-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 MITCHELL WAY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982269175",
            "telephone_number": "360-738-6860",
            "fax_number": "360-738-6853"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN BROCKLIN",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-18",
        "last_updated": "2020-11-19",
        "certification_date": "2020-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001307",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1023190",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2027076",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "00939832",
            "state": "AK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010014",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "410017358",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "michael.vanbrocklin.p1@direct.pcli.nextgenshare.com",
            "affiliation": "N",
            "address_1": "4330 Mitchell Way",
            "city": "Bellingham",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982269175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Melanie Valdez
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• Nichole Valenzuela
• Alexandria Victoria Valline, LMHC
• Erik William Van Amerongen, PHARMD
• Shane J Van Capelle, CG
• Emily Van Deinse, PT, DPT
• Kendra Van Den Top
• John William Van Der Horst
• Douglas William Van Druff II, LMHCA

• Optometrist in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2020; 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.