Ryan Wayne Brack, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

S975TA537 Issued in AL

Practice address

24833 John T Reid Pkwy
Scottsboro, AL 35768-2340

Phone

(256) 574-5698

Fax

(256) 574-6939

NPI assigned

Sep 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AL

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

Specialty

Optometry

Education

Other, 1997

Medicare assignment

May accept Medicare assignment

Group practices

Marx Optical IncGroup PAC ID 4082733258, 7 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Marx Optical Inc

  • Eyewear Supplier
  • Decatur, AL
  • NPI 1942346101
  Medicare reassignment Care Compare group NPD
• R W Brack P C

  • Optometrist
  • Scottsboro, AL
  • NPI 1336350859
  NPD (past) Authorized official
• Elite Eye Care of Huntsville

  • Optometrist
  • Huntsville, AL
  • NPI 1689740995
  NPD

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

{
    "created_epoch": "1158451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609973379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 TAMMY GAINES LN",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358118951",
            "telephone_number": "256-746-0170",
            "fax_number": "256-574-6939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24833 JOHN T REID PKWY",
            "city": "SCOTTSBORO",
            "state": "AL",
            "postal_code": "357682340",
            "telephone_number": "256-574-5698",
            "fax_number": "256-574-6939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRACK",
        "first_name": "RYAN",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S975TA537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF AL",
            "identifier": "51503656",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jana Leigh Blanton, LHIS
• Edythe Bolden
• Morgan Leigh Bone, MS, RD, LD
• Kaitlin Bonner, SLP
• Sarah L Boxley, M.D.
• Bradford Family Healthcare PC
• Barrett Bradford, D.M.D
• Charles Raymond Bradford IV, M.D.
• Charles Raymond Bradford III, M.D.
• Rose Marie Bright, MSW, LICSW, PIP

• Optometrist in Scottsboro, AL
• Providers in Scottsboro, AL by specialty
• Optometrist in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.