Active NPI
Broome Vision Inc
Doing business as Eyesavers
- Optometrist
- Ormond Beach, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC3301
- Legal business name
- BROOME VISION INC
- Doing business as
- Eyesavers
- Practice address
- 1474 W Granada Blvd
Suite 470
Ormond Beach, FL 32174-9187 - Phone
- (386) 673-3011
- NPI assigned
- Jul 11, 2008
- Last updated
- Jun 2, 2011
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kevin Andrew Broome, O.D.
- Title
- President/Owner
- Phone
- (386) 253-5999
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC3301 | FL | Primary |
Addresses
Primary practice location
1474 W Granada Blvd
Suite 470
Ormond Beach, FL 32174-9187
Mailing address
1474 W Granada Blvd
Ste 470
Ormond Beach, FL 32174-9187
Phone (386) 673-3011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000206402 | Medicaid | FL |
Other names 1
- Eyesavers
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080903000609 | FL | Part B Supplier - Clinic/Group Practice | 3678649373 |
Receives reassigned benefits from 4 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Daytona Beach, FL; Ormond Beach, FL; Port Orange, FL |
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Daytona Eye Center
- Optometrist
- Daytona Beach, FL
- NPI 1922278704
O20080903000609
National Provider Directory
National Provider Directory- Tax ID family
- Broome Vision Inc
Other organizations with this tax ID 3
Organizations that report the same tax identification number in the National Provider Directory.
-
- Optometrist
- Port Orange, FL
- NPI 1891958963
Practitioners & affiliated clinicians
Practitioners 3
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.
-
- Optometrist
- Daytona Beach, FL
- NPI 1548296486
-
- Optometrist
- Port Orange, FL
- NPI 1982631792
-
- Optometrist
- Daytona Beach, FL
- NPI 1063416543
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1215734400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1306972800000",
"number": "1689838393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1474 W GRANADA BLVD",
"address_2": "STE 470",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321749187",
"telephone_number": "386-673-3011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1474 W GRANADA BLVD",
"address_2": "SUITE 470",
"city": "ORMOND BEACH",
"state": "FL",
"postal_code": "321749187",
"telephone_number": "386-673-3011"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BROOME VISION INC",
"organizational_subpart": "NO",
"enumeration_date": "2008-07-11",
"last_updated": "2011-06-02",
"status": "A",
"authorized_official_last_name": "BROOME",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "ANDREW",
"authorized_official_title_or_position": "PRESIDENT/OWNER",
"authorized_official_telephone_number": "386-253-5999",
"authorized_official_credential": "O.D."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC3301",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "000206402",
"state": "FL"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Eyesavers",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Ormond Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2011; 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.