NPIMap

Organization Active NPI

Montgomery Village Eyecare Associates, Inc.

Doing business as Dr. Matthew E. Brodak & Associates

  • Corneal and Contact Management Optometrist
  • Gaithersburg, MD
National Provider Identifier
1679853402
Registry record updated May 2, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Corneal and Contact Management OptometristTaxonomy code 152WC0802X
License
TA1115 Issued in MD
Legal business name
MONTGOMERY VILLAGE EYECARE ASSOCIATES, INC.
Doing business as
Dr. Matthew E. Brodak & Associates
Practice address
9673 Lost Knife Rd
Gaithersburg, MD 20877-2622
Phone
(301) 330-4265
Fax
(301) 963-4508
NPI assigned
Aug 24, 2011
Last updated
May 2, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2019

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

Authorized official

Name
Matthew Edward Brodak, O.D.NPI 1477727055
Title
Owner
Phone
(301) 330-4265

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X TA1115 MD Primary

Addresses

Primary practice location

9673 Lost Knife Rd
Gaithersburg, MD 20877-2622

Mailing address

9673 Lost Knife Rd
Gaithersburg, MD 20877-2622
Phone (301) 330-4265

Other names 1

  • Dr. Matthew E. Brodak & Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111209000323 DC Part B Supplier - Clinic/Group Practice 6406021096 Receives reassigned benefits from 1 practitioner
Practice locations: Gaithersburg, MD

National Provider Directory

National Provider Directory

Locations

9673 Lost Knife Rd
Gaithersburg, MD 20877
Phone (301) 330-4265

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1314144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556755200000",
    "number": "1679853402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9673 LOST KNIFE RD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772622",
            "telephone_number": "301-330-4265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9673 LOST KNIFE RD",
            "city": "GAITHERSBURG",
            "state": "MD",
            "postal_code": "208772622",
            "telephone_number": "301-330-4265",
            "fax_number": "301-963-4508"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY VILLAGE EYECARE ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-24",
        "last_updated": "2019-05-02",
        "status": "A",
        "authorized_official_last_name": "BRODAK",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-330-4265",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "MD",
            "license": "TA1115",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr. Matthew E. Brodak & Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Dr. Matthew E. Brodak & Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaithersburg, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.