John H Broaddus, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG001548 Issued in PA

Practice address

471 Park City Ctr
Lancaster, PA 17601-2711

Phone

(717) 393-4042

NPI assigned

Jul 7, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

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

Practice roles

Locations

Practitioners 1

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

• Gary John Gydush, OD

  • Optometrist
  • Lancaster, PA
  • NPI 1164501979
  Medicare reassignment

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• John H Broaddus

  • Optometrist
  • Lancaster, PA
  • NPI 1265538045
  NPD (past) Authorized official
• Luxottica of America Inc.

  • Eyewear Supplier
  • Lancaster, PA
  • NPI 1194878827
  NPD

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649548800000",
    "number": "1477551133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "471 PARK CITY CTR",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176012711",
            "telephone_number": "717-393-4042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "471 PARK CITY CTR",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176012711",
            "telephone_number": "717-393-4042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADDUS",
        "first_name": "JOHN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2022-04-10",
        "certification_date": "2022-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PROVIDER #",
            "identifier": "57761",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Brinkos, LSW
• Brian Thomas Brislin, MD
• Tyrone Gary Bristol, M.D.
• Frank Vincent Brizzi, PA-C
• Jerome Broad, CRNA
• Hannah Broadway
• Ashley E. Broberg, LCSW
• Joy Diana Brobst, LCSW
• Nolah Brockington, LPN
• Bruce A Brod, M.D.

• Optometrist in Lancaster, PA
• Providers in Lancaster, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2022; 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.