Michael L Brian, OD
Individual provider Active NPI Optometrist · Henryetta, OK
NPI 1790726842 · NPPES record last updated Sep 13, 2012
Key facts
- NPI
- 1790726842
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1024 (OK)
- Practice address
- 900 W Main St
Henryetta, OK 74437-4252 - Phone
- (918) 652-2345
- Fax
- (918) 652-2537
- NPI assigned
- Jun 9, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051104000088 | OK | Practitioner - Optometry | 8123046562 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1024 | OK | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Henryetta Eye Center | Optometrist | Current |
Accepting new patients |
Locations
900 W Main St
Henryetta, OK 74437
Phone (918) 652-2345
Interoperability endpoints
- michael.brian@direct.revolutionehr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1024 | OK | Yes |
Addresses
Primary practice location
900 W Main St
Henryetta, OK 74437-4252
Mailing address
900 W Main St
Henryetta, OK 74437-4252
Phone (918) 652-2345
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100763680A | Medicaid | OK | |
| 410036906 | Other | OK | RAIL ROAD MEDICARE |
| P00711249 | Other | OK | RAIL ROAD MEDICARE |
Other names
- Henryetta Eye Center
Other providers in Henryetta, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.