Northland Eye Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

183-0 Issued in MO

Legal business name

NORTHLAND EYE SURGERY CENTER, LLC

Practice address

100 N Clayview Dr
Suite a
Liberty, MO 64068-1117

Phone

(816) 792-1900

Fax

(816) 792-3548

NPI assigned

Aug 18, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Tyler F Brundige, M.D.

Title

President

Phone

(816) 792-1900

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Listed as

Northland Eye Surgery Center LLCCCN 26C0001113

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1155859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1598879512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N CLAYVIEW DR",
            "address_2": "SUITE A",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640681117",
            "telephone_number": "816-792-1900",
            "fax_number": "816-792-3548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N CLAYVIEW DR",
            "address_2": "SUITE A",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640681117",
            "telephone_number": "816-792-1900",
            "fax_number": "816-792-3548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND EYE SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRUNDIGE",
        "authorized_official_first_name": "TYLER",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "816-792-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MO",
            "license": "183-0",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Jeanne Nordhues, RN,MSN,ARNP
• Northland Chest Consultants, Inc.
• Northland Dependency Services, LLC
• Northland Ear Nose & Throat PC
• Northland Eye Specialists PC
• Northland Hearing Associates, Inc.
• Northland Hearing Centers, Inc. (Audibel Hearing Center)
• Northland O&P LLC
• Northland Obstetrics & Gynecology, Inc.
• Northland Optical Center, LLC

• Ambulatory Surgical Clinic/Center in Liberty, MO
• Providers in Liberty, MO by specialty
• Ambulatory Surgical Clinic/Center in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.