Active NPI
Gary T Brotherson MD Inc
Doing business as Niagara Eye Associates
- Optometrist
- Erie, PA
National Provider Identifier
1801818810
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OEG001090
- Legal business name
- GARY T BROTHERSON MD INC
- Doing business as
- Niagara Eye Associates
- Practice address
- 1801 W 8TH St
Erie, PA 16505-4938 - Phone
- (814) 455-8004
- Fax
- (814) 456-6054
- NPI assigned
- Jul 25, 2006
- Last updated
- Aug 31, 2010
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gary Brotherson, MD
- Title
- President
- Phone
- (814) 455-8004
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OEG001090 | PA | Primary |
Addresses
Primary practice location
1801 W 8TH St
Erie, PA 16505-4938
Mailing address
1801 W 8TH St
Erie, PA 16505-4938
Phone (814) 455-8004
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060638 | Other | PA | PTAN |
| 410040784 | Other | PA | MEDICARE RAILROAD |
| OEG001090 | Other | PA | HETRICK LICENCE |
| 436660 | Other | PA | HETRICK IND HIGHMARLK/VIS |
| 1466887 | Other | PA | HIGHMARK MEDICAL |
| 1942274691 | Other | PA | HETRICK NPI |
| 0070886470002 | Medicaid | PA |
Other names 1
- Niagara Eye Associates
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in PA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050414000683 | PA | Part B Supplier - Clinic/Group Practice | 6406893056 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Erie, PA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Niagara Eye Associates
- Ophthalmology Physician
- Erie, PA
- NPI 1497788087
O20050414000683
National Provider Directory
National Provider Directory- Tax ID family
- Gary T Brotherson MD Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Practitioners & affiliated clinicians
Practitioners 3
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Ophthalmology Physician
- Erie, PA
- NPI 1932173754
-
- Optometrist
- Erie, PA
- NPI 1942274691
-
- Optometrist
- Cleveland, OH
- NPI 1497246458
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1283212800000",
"number": "1801818810",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1801 W 8TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165054938",
"telephone_number": "814-455-8004",
"fax_number": "814-456-6054"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 W 8TH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165054938",
"telephone_number": "814-455-8004",
"fax_number": "814-456-6054"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GARY T BROTHERSON MD INC",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-25",
"last_updated": "2010-08-31",
"status": "A",
"authorized_official_last_name": "BROTHERSON",
"authorized_official_first_name": "GARY",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "814-455-8004",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "OEG001090",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "060638",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "410040784",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HETRICK LICENCE",
"identifier": "OEG001090",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HETRICK IND HIGHMARLK/VIS",
"identifier": "436660",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HIGHMARK MEDICAL",
"identifier": "1466887",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HETRICK NPI",
"identifier": "1942274691",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0070886470002",
"state": "PA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Niagara Eye Associates",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2010; 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.