Ernest Dale Brock, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

046-006814 Issued in IL

Practice address

202 E Clark St
West Frankfort, IL 62896-2706

Phone

(618) 937-3126

Fax

(618) 937-3344

NPI assigned

Jun 1, 2005

Sex

Male

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234828800000",
    "number": "1538161708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "202 E CLARK ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962706",
            "telephone_number": "618-937-3126",
            "fax_number": "618-937-3344"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "202 E CLARK ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962706",
            "telephone_number": "618-937-3126",
            "fax_number": "618-937-3344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "ERNEST",
        "middle_name": "DALE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2009-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046-006814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Helen Blackburn
• Gloria Bluemel
• Dakota Bowen
• Seth Bradley
• Dakota Brauninger, BSW
• Zenobia Brock
• Tina E Brooks, MSED
• Brian Brown
• Amy L Broy, DT
• Jennifer Buchanan

• Optometrist in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.