NPIMap

Organization Active NPI

Bruch Eyecare & Associates, Inc.

  • Optometrist
  • Marion, OH
National Provider Identifier
1720382096
Registry record updated Jul 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5096 Issued in OH
Legal business name
BRUCH EYECARE & ASSOCIATES, INC.
Practice address
150 McMahan Blvd
Marion, OH 43302-5654
Phone
(740) 389-1300
Fax
(740) 389-1335
NPI assigned
Dec 30, 2010
Last updated
Jul 16, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2014

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

Authorized official

Name
Dr. Kelly Lyn Bruch, ODNPI 1164426078
Title
President
Phone
(740) 389-1300

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
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 5096 OH Primary

Addresses

Primary practice location

150 McMahan Blvd
Marion, OH 43302-5654

Mailing address

150 McMahan Blvd
Marion, OH 43302-5654
Phone (740) 389-1300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140923001108 OH Part B Supplier - Clinic/Group Practice 3870712961 Receives reassigned benefits from 3 practitioners
Practice locations: Marion, OH

National Provider Directory

National Provider Directory

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.

NPI Registry JSON

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

{
    "created_epoch": "1293667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405468800000",
    "number": "1720382096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MCMAHAN BLVD",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433025654",
            "telephone_number": "740-389-1300",
            "fax_number": "740-389-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MCMAHAN BLVD",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433025654",
            "telephone_number": "740-389-1300",
            "fax_number": "740-389-1335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUCH EYECARE & ASSOCIATES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-30",
        "last_updated": "2014-07-16",
        "status": "A",
        "authorized_official_last_name": "BRUCH",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "740-389-1300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "5096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2014; 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.