Individual provider Active NPI

Bradley K Farris, M.D.

  • Neuro-ophthalmology Physician
  • Oklahoma City, OK
National Provider Identifier
1841267291
Registry record updated May 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuro-ophthalmology PhysicianTaxonomy code 207WX0109X
License
13105 Issued in OK
Practice address
608 Stanton L Young Blvd
Oklahoma City, OK 73104
Phone
(405) 271-1091
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 13105 OK
Neuro-ophthalmology Physician 207WX0109X 13105 OK Primary

Addresses

Primary practice location

608 Stanton L Young Blvd
Oklahoma City, OK 73104

Mailing address

608 Stanton L Young Blvd
Oklahoma City, OK 73104-5014
Phone (405) 271-1091

Other identifiers 1

IdentifierTypeStateIssuer
100629440DMedicaidOK

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050824000793 OK Practitioner - Ophthalmology 5496786980 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
13105OKMDNeuro-ophthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Oklahoma Heal Sci Ctr College of Medicine Ophthalmology Ophthalmology CurrentSince Jul 1, 1981 Accepting new patients

Locations

608 Stanton L Young Blvd
Oklahoma City, OK 73104
Phone (405) 271-6060

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526342400000",
    "number": "1841267291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "608 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045014",
            "telephone_number": "405-271-1091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "608 STANTON L YOUNG BLVD",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73104",
            "telephone_number": "405-271-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARRIS",
        "first_name": "BRADLEY",
        "middle_name": "K",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2018-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "OK",
            "license": "13105",
            "primary": false
        },
        {
            "code": "207WX0109X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Neuro-ophthalmology",
            "state": "OK",
            "license": "13105",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100629440D",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2018; 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.