Kacie A Breault, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2382 Issued in SC

Practice address

2077 Parkway Dr Ste 102
Indian Land, SC 29707-8088

Phone

(839) 293-0292

Fax

(839) 293-0293

NPI assigned

Apr 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

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

Pennsylvania College of Optometry, 2005

Medicare assignment

May accept Medicare assignment

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.

• Accuvision Eye Care OD, PA

  • Optometrist
  • Gastonia, NC
  • NPI 1174850168

  Optometrist, SC

  Medicare reassignment NPD
• Sunrise Anesthesia Associates PA

  • Anesthesiology Physician
  • Coral Springs, FL
  • NPI 1790881183
  NPD (past)

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751846400000",
    "number": "1720100415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2077 PARKWAY DR STE 102",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297078088",
            "fax_number": "839-293-0293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2077 PARKWAY DR STE 102",
            "city": "INDIAN LAND",
            "state": "SC",
            "postal_code": "297078088",
            "telephone_number": "839-293-0292",
            "fax_number": "839-293-0293"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREAULT",
        "first_name": "KACIE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2025-07-07",
        "certification_date": "2025-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC 4002",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "SC",
            "license": "2382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Scott Boney, PHARMD
• Nam Gin Paul Bowman
• Jessica Bradburn, DC
• Brain Restoration Clinic, PLLC
• Renee E Brassell, RN
• Kerry Patterson Briones, MD
• Kimberly Hrobak Bumgardner, OTR/L
• George Archibald Butler, MD
• Colleen Marie Caffrey-Thrasher, LAC. DIPLAC, MAC
• Stephen Calderalo

• All providers in Indian Land, SC
• Optometrist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2025; 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.