Luke Dewey Brog, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

296T Issued in WY

Practice address

122 Petersen Parkway
Suite 1
Thayne, WY 83127

Phone

(307) 883-4678

NPI assigned

Nov 17, 2006

Last updated

Jul 9, 2007By the provider in NPPES

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WY

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

Other, 2005

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

0 of 100Reported as individual

Quality

0

Improvement activities

0

Cost

0

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Lower Valley Vision Clinic Inc

  • Optometrist
  • Thayne, WY
  • NPI 1336212158
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1831262641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 800",
            "city": "THAYNE",
            "state": "WY",
            "postal_code": "831270800",
            "telephone_number": "307-883-4678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 PETERSEN PARKWAY",
            "address_2": "SUITE 1",
            "city": "THAYNE",
            "state": "WY",
            "postal_code": "83127",
            "telephone_number": "307-883-4678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROG",
        "first_name": "LUKE",
        "middle_name": "DEWEY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WY",
            "license": "296T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ALTIUS HEALTH PLANS",
            "identifier": "285174",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CBSA",
            "identifier": "5646844",
            "state": "WY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "313773",
            "state": "WY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Access Home Care LLC
• Access Hospice Care LLC
• Alliance Hospice of Star Valley
• Lisa Ashment
• Julie Balsamo, MS, RDN
• Broulim Supermarkets, LLC (Broulim's Pharmacy #4 - Thayne)
• Clancy Clyde Brown, DPT, CSCS
• Hayden Glen Datwyler, DPT
• Dawn Davis
• Haylee Eggleston

• Optometrist in Thayne, WY
• Providers in Thayne, WY by specialty
• Optometrist in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.