Individual provider Active NPI

Larry J Brothers, O.D.

  • Optometrist
  • Joplin, MO
National Provider Identifier
1740287952
Registry record updated Jan 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T02605 Issued in MO
Practice address
2013 S Joplin Ave
Joplin, MO 64804-2033
Phone
(417) 624-5005
Fax
(417) 624-5215
NPI assigned
Jul 1, 2005
Last updated
Jan 17, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T02605 MO Primary

Addresses

Primary practice location

2013 S Joplin Ave
Joplin, MO 64804-2033

Mailing address

4777 Seagraves Dr
Joplin, MO 64804-5550
Phone (417) 782-1133

Other identifiers 1

IdentifierTypeStateIssuer
32594OtherMOBCBS

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20120601000253 MO Practitioner - Optometry 7517076425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Brothers Taylor and Bezold IncGroup PAC ID 3173576253, 4 clinicians

Practice addresses (Care Compare)

2013 S Joplin Ave
Joplin, MO 64804-2033
Phone (417) 624-5005

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery28

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T02605MOMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Brothers Taylor & Bezold Inc Optometrist CurrentSince Dec 31, 1991 Accepting new patients

Locations

2013 S Joplin Ave
Joplin, MO 64804
Phone (417) 624-5005

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1200528000000",
    "number": "1740287952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4777 SEAGRAVES DR",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648045550",
            "telephone_number": "417-782-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2013 S JOPLIN AVE",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042033",
            "telephone_number": "417-624-5005",
            "fax_number": "417-624-5215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROTHERS",
        "first_name": "LARRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2008-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "T02605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "32594",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

Verify at the official NPI Registry.