Individual provider Active NPI

Brad E Hanstad, OD

  • Optometrist
  • Plano, TX
National Provider Identifier
1609856236
Registry record updated Jun 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7943T Issued in TX
Practice address
5044 Tennyson Pkwy Ste B
Plano, TX 75024-2953
Phone
(972) 378-4104
Fax
(972) 378-9094
NPI assigned
Jan 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 19, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 7943T TX Primary

Addresses

Primary practice location

5044 Tennyson Pkwy Ste B
Plano, TX 75024-2953

Mailing address

5044 Tennyson Pkwy
Ste B
Plano, TX 75024-2953
Phone (972) 378-4104

Other identifiers 1

IdentifierTypeStateIssuer
800558OtherNDBLUE CROSS VISION

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20130619000142 TX Practitioner - Optometry 8224179700 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern California College of Optometry, 1996
Medicare assignment
May accept Medicare assignment
Group practices
Todd R Brantley LLCGroup PAC ID 7416194725, 4 clinicians
Todd Brantley, OD PAGroup PAC ID 4284760414, 6 clinicians

Practice addresses (Care Compare)

1060 Preston Rd
Suite 100
Celina, TX 75009
Phone (972) 382-2020

5044 Tennyson Pkwy
Suite B
Plano, TX 75024-2953
Phone (972) 378-4104

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery21

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7943TXMDChiropractor
7943TTXMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Todd Brantley, OD PA Optometrist CurrentSince Mar 9, 2013 Accepting new patients
Todd R. Brantley, LLC Optometrist CurrentSince Dec 7, 2013 Accepting new patients
Advanced Vision Centers PC Optometrist Past Accepting new patients

Locations

205 S Preston Rd
Ste 120
Celina, TX 75009
Phone (972) 382-2020

1060 S Preston Rd
Ste 100
Celina, TX 75009
Phone (972) 382-2020

5044 Tennyson Pkwy
Ste B
Plano, TX 75024
Phone (972) 378-4104

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560902400000",
    "number": "1609856236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5044 TENNYSON PKWY",
            "address_2": "STE B",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750242953",
            "telephone_number": "972-378-4104",
            "fax_number": "972-378-9094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5044 TENNYSON PKWY STE B",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750242953",
            "telephone_number": "972-378-4104",
            "fax_number": "972-378-9094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANSTAD",
        "first_name": "BRAD",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2019-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "7943T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS VISION",
            "identifier": "800558",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plano, TX

Sources for this page

Verify at the official NPI Registry.