Northside Eye Center LLC

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

NORTHSIDE EYE CENTER LLC

Practice address

9610 Lima Road
Suite 103
Fort Wayne, IN 46818-9998

Phone

(260) 440-8388

Fax

(260) 999-5645

NPI assigned

Aug 10, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Brandon Callow, ODNPI 1639522642

Title

Optometrist

Phone

(260) 255-0654

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Practitioners 1

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

• Brandon Callow, O.D.

  • Optometrist
  • Fort Wayne, IN
  • NPI 1639522642
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1691625600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1770266322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9610 LIMA ROAD",
            "address_2": "SUITE 103",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468180104",
            "telephone_number": "260-440-8388",
            "fax_number": "260-999-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9610 LIMA ROAD",
            "address_2": "SUITE 103",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468189998",
            "telephone_number": "260-440-8388",
            "fax_number": "260-999-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHSIDE EYE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-08-10",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-07",
        "status": "A",
        "authorized_official_last_name": "CALLOW",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "260-255-0654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Northern Indiana Interim Healthcare (Interim HomeStyle Services of Fort Wayne)
• Northern Indiana Interim Healthcare Company LLC (Interim Healthcare of Fort Wayne)
• Northern Indiana Neonatal Associates, PC
• Northland Hearing Center, Inc. (Carter Hearing Clinics)
• Northland Hearing Centers, Inc. (Carter Hearing Clinics)
• Northwest Allen County Schools
• Aaron Joseph Norton, CRNA
• Andrew Joseph Norton, M.D.
• Jonathan VN Norton, D.P.M.
• Rita L. Norton, LPN

• Optometrist in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Optometrist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.