Bradley R Wimmer, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1270-02 Issued in KS

Practice address

411 E Centennial Dr
Pittsburg, KS 66762-6505

Phone

(620) 232-1005

Fax

(620) 231-5821

NPI assigned

Jul 12, 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

Not listed in the public Medicare enrollment file

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.

• Gracie Chase Avery, LLC

  • Optometrist
  • Joplin, MO
  • NPI 1003320607
  NPD

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

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1414454400000",
    "number": "1699700807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 E CENTENNIAL DR",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667626505",
            "telephone_number": "620-232-1005",
            "fax_number": "620-231-5821"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E CENTENNIAL DR",
            "city": "PITTSBURG",
            "state": "KS",
            "postal_code": "667626505",
            "telephone_number": "620-232-1005",
            "fax_number": "620-231-5821"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIMMER",
        "first_name": "BRADLEY",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-12",
        "last_updated": "2014-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1270-02",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100219350B",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kyle E Willard
• Krista Lynn Williams-Mijares, MD
• Christopher M Wilson, PT
• Wimmer P.a.
• Wimmer Physical Therapy PA
• Carol Lynn Wimmer, PT
• Alexandria Winter
• Emily Winter, DC
• Brandi Kay Wolf, PHARM.D.
• Robin F. Wood, DDS

• All providers in Pittsburg, KS
• Optometrist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.