Stephen Brockbank, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5601485-9934 Issued in UT

Practice address

222 S Main St
Suite 110
Salt Lake City, UT 84101-2174

Phone

(801) 456-2020

Fax

(801) 456-2021

NPI assigned

Aug 25, 2006

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

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Optometry

Education

Southern California College of Optometry, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympus Eye Associates PCGroup PAC ID 9739360181, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

94.49 of 100Reported as group

Quality

100

Improvement activities

40

Cost

81.62

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Olympus Eye Associates, PC

  • Ophthalmology Physician
  • Murray, UT
  • NPI 1912202425
  Medicare reassignment Care Compare group NPD
• Insight Eye Care LLC

  • Optician
  • Provo, UT
  • NPI 1689857302
  NPD
• Total Vision Care, LLC

  • Optometrist
  • Riverton, UT
  • NPI 1649460668
  NPD (past)
• Wilson Polito PLLC

  • Optometrist
  • Lewiston, ID
  • NPI 1710276324
  NPD (past)

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

{
    "created_epoch": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370304000000",
    "number": "1508973397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2847 N 1050 E",
            "city": "LEHI",
            "state": "UT",
            "postal_code": "840434033",
            "telephone_number": "801-456-2020",
            "fax_number": "801-456-2021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 S MAIN ST",
            "address_2": "SUITE 110",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841012174",
            "telephone_number": "801-456-2020",
            "fax_number": "801-456-2021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCKBANK",
        "first_name": "STEPHEN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2013-06-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "5601485-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keila Izcalli Nuila Broadhead
• Paul M Broadwater, D.D.S.
• Broadway Inc.
• Aubrey Noel Brock
• Laura Lyn Brockbank, PH.D.
• Mariah Brockman, LAMFT
• Douglas L. Brockmeyer, MD
• Bridget Ashley Brocksmith
• Mark Brocksmith
• Taryn Janae Broderick

• Optometrist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 4, 2013; 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.