Individual provider Active NPI

Stephen Michael Brzytwa, O.D.

  • Optometrist
  • Decatur, AL
National Provider Identifier
1740344548
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
S-944-TA-509 Issued in AL
Practice address
2620 Centron Dr SW
Decatur, AL 35603-2500
Phone
(256) 350-6655
Fax
(256) 350-2548
NPI assigned
Dec 19, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X S-944-TA-509 AL Primary

Addresses

Primary practice location

2620 Centron Dr SW
Decatur, AL 35603-2500

Mailing address

58 Deerfield Dr
Decatur, AL 35603-5269
Phone (256) 350-7365

Other identifiers 6

IdentifierTypeStateIssuer
AL0509OtherALEYEMED
36568-003OtherALGE DAVIS
222816OtherALCOLE VISION LOC. 133157
11357OtherALSPECTERA
2549057OtherALUNITED HEALTH CARE
515-23772OtherALBLUE CROSS & BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20040618000354 AL Practitioner - Optometry 4183609878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1998
Medicare assignment
May accept Medicare assignment
Group practices
Marx Optical IncGroup PAC ID 4082733258, 7 clinicians

Practice addresses (Care Compare)

2620 Centron Dr SW
Decatur, AL 35603-2500
Phone (256) 350-6655

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S-944-TA-509ALMDOptometrist
1114SCMDOccupational Therapist

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": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1740344548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "58 DEERFIELD DR",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356035269",
            "telephone_number": "256-350-7365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 CENTRON DR SW",
            "city": "DECATUR",
            "state": "AL",
            "postal_code": "356032500",
            "telephone_number": "256-350-6655",
            "fax_number": "256-350-2548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRZYTWA",
        "first_name": "STEPHEN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-944-TA-509",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "AL0509",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GE  DAVIS",
            "identifier": "36568-003",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLE VISION  LOC. 133157",
            "identifier": "222816",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "11357",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2549057",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "515-23772",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, AL

Sources for this page

Verify at the official NPI Registry.