Individual provider Active NPI

Brett Norman Hagen, O.D.

  • Optometrist
  • Spokane, WA
National Provider Identifier
1518052091
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3101TX Issued in WA
Practice address
521 W. Garland Avenue
Spokane, WA 99205-2954
Phone
(509) 327-9505
Fax
(509) 325-3277
NPI assigned
Oct 3, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3101TX WA Primary

Addresses

Primary practice location

521 W. Garland Avenue
Spokane, WA 99205-2954

Mailing address

521 W. Garland Avenue
Spokane, WA 99205-2954
Phone (509) 327-9505

Other identifiers 4

IdentifierTypeStateIssuer
E08254OtherWAKCMB SHIELD
4008190001OtherWADMERC
2024560MedicaidWA
0145801OtherWAL & I

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20040503000000 WA Practitioner - Optometry 1052309853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Garland Vision Source IncGroup PAC ID 8123139425, 3 clinicians

Practice addresses (Care Compare)

521 W Garland Ave
Spokane, WA 99205-2954

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery25

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3101TXWAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Garland Vision Source, Inc. Optometrist CurrentSince Mar 7, 2001 Accepting new patients

Locations

521 W Garland Ave
Spokane, WA 99205
Phone (509) 327-9505

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1518052091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "521 W. GARLAND AVENUE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992052954",
            "telephone_number": "509-327-9505",
            "fax_number": "509-325-3277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "521 W. GARLAND AVENUE",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992052954",
            "telephone_number": "509-327-9505",
            "fax_number": "509-325-3277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAGEN",
        "first_name": "BRETT",
        "middle_name": "NORMAN",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3101TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KCMB SHIELD",
            "identifier": "E08254",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "4008190001",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2024560",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0145801",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

Verify at the official NPI Registry.