Brandyn Wyatt, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4683ATI Issued in OR

Practice address

90 Market St Ste 20
Lebanon, OR 97355-2396

Phone

(541) 451-2020

Fax

(541) 451-1785

NPI assigned

Jun 19, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

Specialty

Optometry

Education

Pacific University - College of Optometry, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lifetime Vision Source of Lebanon LLCGroup PAC ID 6608773148, 3 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lifetime Vision Source of Lebanon LLC

  • Optometrist
  • Lebanon, OR
  • NPI 1710168877
  Medicare reassignment Care Compare group NPD
• Eyecare Associates PC

  • Ophthalmology Physician
  • Albany, OR
  • NPI 1013964113

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1687132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687132800000",
    "number": "1821773722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "90 MARKET ST STE 20",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552396",
            "telephone_number": "541-451-2020",
            "fax_number": "541-451-1785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 MARKET ST STE 20",
            "city": "LEBANON",
            "state": "OR",
            "postal_code": "973552396",
            "telephone_number": "541-451-2020",
            "fax_number": "541-451-1785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "BRANDYN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-19",
        "last_updated": "2023-06-19",
        "certification_date": "2023-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "4683ATI",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Micah Akm Wong, DPT
• Robert Woodruff
• Trey Woods, D.O.
• Richard C. Wopat, M.D.
• Wyatt Osborne, DMD, LLC
• Carli Wymore, CPT
• Jessica Michelle Wynn
• Leanna Wynne
• Craig Yamaguchi
• Samantha Yasueda

• Optometrist in Lebanon, OR
• Providers in Lebanon, OR by specialty
• Optometrist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.