Individual provider Active NPI

Jennifer Brooks, O.D.

  • Optometrist
  • Edmond, OK
National Provider Identifier
1487845848
Registry record updated Jul 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2544 Issued in OK
Practice address
1200 NW 178TH St
Ste 100
Edmond, OK 73012
Phone
(405) 509-2100
Fax
(405) 509-2288
NPI assigned
Aug 9, 2007
Last updated
Jul 8, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2544 OK Primary

Addresses

Primary practice location

1200 NW 178TH St
Ste 100
Edmond, OK 73012

Mailing address

1200 NW 178TH St
Ste 100
Edmond, OK 73012
Phone (405) 509-2100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK
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

Enrollment IDStateProvider typePAC IDDetails
I20080612000367 OK Practitioner - Optometry 3375614795 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovative EyecareGroup PAC ID 4486843513, 3 clinicians

Practice addresses (Care Compare)

1200 NW 178TH St
Suite 100
Edmond, OK 73012-4463
Phone (405) 509-2100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2544OKMDRegistered Dietitian

Practice roles

OrganizationSpecialtyStatusNew patients
Innovative Eyecare Optometrist CurrentSince Dec 15, 2010 Accepting new patients

Locations

1200 NW 178th St
Ste 100
Edmond, OK 73012
Phone (405) 509-2100

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1186617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625702400000",
    "number": "1487845848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 NW 178TH ST",
            "address_2": "STE 100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73012",
            "telephone_number": "405-509-2100",
            "fax_number": "405-509-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 NW 178TH ST",
            "address_2": "STE 100",
            "city": "EDMOND",
            "state": "OK",
            "postal_code": "73012",
            "telephone_number": "405-509-2100",
            "fax_number": "405-509-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROOKS",
        "first_name": "JENNIFER",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-09",
        "last_updated": "2021-07-08",
        "certification_date": "2021-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edmond, OK

Sources for this page

Verify at the official NPI Registry.