Dickman Kettler & Bruner Inc
Organization Active NPI Optometrist · Coldwater, OH
NPI 1558478453 · NPPES record last updated Apr 9, 2008
Key facts
- NPI
- 1558478453
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- DICKMAN KETTLER & BRUNER INC
- Practice address
- 201 S 2ND St
Coldwater, OH 45828-1747 - Phone
- (419) 678-3016
- Fax
- (419) 678-8849
- NPI assigned
- Aug 24, 2006
- Organization subpart
- No
Authorized official
- Name
- Jillynn F Bruner, OD
- Title
- Vice President
- Phone
- (419) 678-3016
Practitioners 12
-
Jillynn F Bruner, OD
-
Calen Bruner, OD
-
Alicia W Tobe, O.D.
-
Tyler James Speelman, O.D.
-
Wayne R Kettler, OD
-
Mark B Vallo, O.D.
-
W Victor Vonblon, OD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| DRS Dickman Kettler & Bruner |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses|Prosthetic Lenses: Prosthetics Cataract Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061204000310 | OH | Part B Supplier - Clinic/Group Practice | 1759380694 |
Receives reassigned benefits from 6 practitioners Practice locations: Coldwater, OH; Englewood, OH; Greenville, OH; Saint Marys, OH |
| O20100930079158 | OH | DME Supplier - Physician - Optometrist | 1759380694 | Practice locations: Coldwater, OH |
National Provider Directory
Locations
201 S 2nd St
Coldwater, OH 45828
Phone (419) 678-3016
5164 Childrens Home Bradford Rd
#R
Greenville, OH 45331
5164 Childrens Home Rd
Greenville, OH 45331
Phone (937) 459-5095
250 Greenville Rd
Saint Marys, OH 45885
Phone (419) 394-5184
Interoperability endpoints
- atobe@professionalfamilyeyecare.eyefinity-direct.com
- jdickman@professionalfamilyeyecare.eyefinity-direct.com
- jbruner@professionalfamilyeyecare.eyefinity-direct.com
- tspeelman@professionalfamilyeyecare.eyefinity-direct.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes |
Addresses
Primary practice location
201 S 2ND St
Coldwater, OH 45828-1747
Mailing address
PO Box 95
201 S Second St
Coldwater, OH 45828-0095
Phone (419) 678-3016
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0611190 | Medicaid | OH |
Other providers in Coldwater, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.