Brookhaven Family Eye Care Center

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG001547 Issued in PA

Legal business name

BROOKHAVEN FAMILY EYE CARE CENTER

Practice address

4106 Edgmont Ave
Brookhaven, PA 19015-2314

Phone

(610) 872-8989

Fax

(610) 872-5220

NPI assigned

Aug 5, 2006

Organization subpart

No

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

Authorized official

Name

Micaela L Small, ODNPI 1619461704

Title

President

Phone

(610) 872-8989

Specialties & licenses 2

Addresses

Other identifiers 5

Other names 1

• BROOKHAVEN VISION SOURCE Doing business as

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Micaela L Small

  • Optometrist
  • Huntingdon Valley, PA
  • NPI 1619461704
  Medicare reassignment NPD Authorized official
• Jacqueline Rita De Jesse, OD

  • Optometrist
  • Brookhaven, PA
  • NPI 1164419115
  NPD

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

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1760490494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 EDGMONT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152314",
            "telephone_number": "610-872-8989",
            "fax_number": "610-872-5220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 EDGMONT AVE",
            "city": "BROOKHAVEN",
            "state": "PA",
            "postal_code": "190152314",
            "telephone_number": "610-872-8989",
            "fax_number": "610-872-5220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BROOKHAVEN FAMILY EYE CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "SMALL",
        "authorized_official_first_name": "MICAELA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "610-872-8989",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001547",
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "PA",
            "license": "OEG001547",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA GROUP HMO",
            "identifier": "2628516",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CM9120",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA UNIVERSAL GROUP",
            "identifier": "5498366",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDEPENDENCE BLUE CROSS",
            "identifier": "2115330000",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIGHMARK",
            "identifier": "001429488",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BROOKHAVEN VISION SOURCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Lionel Berman, DPM
• Lorraine Claudia Blagman, CRNP FAMILY HEALTH
• Richard Francis Blonski, D.M.D.
• Marjorie G. Bowen, CRNP
• Brookhaven Family Dentistry
• Brookhaven Fire Company
• Brown Reentry Consulting LLC
• Ahmedi Bushra, DMD
• Craig A Cassey, O.D.
• Casseys Optical, Inc

• All providers in Brookhaven, PA
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.