Kenneth W. Brawner, O.D.
Individual provider Active NPI Optometrist · Goodlettsville, TN
NPI 1477545341 · NPPES record last updated Mar 22, 2012
Key facts
- NPI
- 1477545341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ODT690 (TN)
- Practice address
- 900 Conference Dr
Suite 15-B
Goodlettsville, TN 37072-1909 - Phone
- (615) 859-1912
- Fax
- (615) 859-1965
- NPI assigned
- Aug 17, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- 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 |
|---|---|---|---|---|
| I20120424000418 | TN | Practitioner - Optometry | 5799947529 | Practice locations: Goodlettsville, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ODT690 | TN | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Eye Clinic of Goodlettsville, PC | Optometrist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | ODT690 | TN | Yes |
Addresses
Primary practice location
900 Conference Dr
Suite 15-B
Goodlettsville, TN 37072-1909
Mailing address
900 Conference Dr
Suite 15-B
Goodlettsville, TN 37072-1909
Phone (615) 859-1912
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3594517 | Medicaid | TN |
Other providers in Goodlettsville, TN
- John Boyd Jr.
- Susan Bracey
- Katie Elizabeth Bradford
- Michelle L. Bradshaw
- John Matthew Bratcher
- Quintina Brewer
- Kerry Wade Brito
- Tomasa Rosanna Brito
- Michael Dorwin Broadnax II
- Brookdale Senior Living Communities, Inc.
All providers in Goodlettsville, TN · Optometrist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2012. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.