Broadway Vision Source, Incorporated

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

BROADWAY VISION SOURCE, INCORPORATED

Practice address

300 W Broadway St
Eagle Grove, IA 50533-1712

Phone

(515) 448-3813

Fax

(515) 448-3885

NPI assigned

Nov 14, 2018

Last updated

Nov 14, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

BROADWAY VISION SOURCE, INCORPORATEDAs reported in NPPES

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

Authorized official

Name

Brandon S Hauck, O.DNPI 1346620432

Title

Owner

Phone

(515) 448-3813

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IA2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Part of

Broadway Vision Source Incorporated

Locations

Practitioners 2

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.

• Brandon Steven Hauck, O.D.

  • Optometrist
  • Fort Dodge, IA
  • NPI 1346620432
  Medicare reassignment NPD Authorized official
• John A Gazaway, OD

  • Optometrist
  • Laurie, MO
  • NPI 1114011913
  NPD (past)

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

{
    "created_epoch": "1542153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1542153600000",
    "number": "1710456249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY ST",
            "address_2": "P.O BOX 459",
            "city": "EAGLE GROVE",
            "state": "IA",
            "postal_code": "505331712",
            "telephone_number": "515-448-3813",
            "fax_number": "515-448-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W BROADWAY ST",
            "city": "EAGLE GROVE",
            "state": "IA",
            "postal_code": "505331712",
            "telephone_number": "515-448-3813",
            "fax_number": "515-448-3885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROADWAY VISION SOURCE, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROADWAY VISION SOURCE, INCORPORATED",
        "enumeration_date": "2018-11-14",
        "last_updated": "2018-11-14",
        "status": "A",
        "authorized_official_last_name": "HAUCK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "515-448-3813",
        "authorized_official_credential": "O.D"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1346620432",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI",
            "identifier": "1346620432",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Janet E B Bade, RPH
• Gregory Jon Burmeister, D.C.
• City of Eagle Grove (City of Eagle Grove Ambulance Service)
• Coleman Counseling, Inc.
• Jill Coleman
• Community Health Center of Fort Dodge, Inc. (Community Health Center of Eagle Grove)

• Optometrist in Eagle Grove, IA
• Providers in Eagle Grove, IA by specialty
• Optometrist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.