NPIMap

Organization Active NPI

Breiwa Ware & Jeskie PSC

Doing business as Vison Source of Bowling Green

  • Optometrist
  • Bowling Green, KY
National Provider Identifier
1841331691
Registry record updated Sep 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BREIWA WARE & JESKIE PSC
Doing business as
Vison Source of Bowling Green
Practice address
335 New Towne Rd
Bowling Green, KY 42103-7966
Phone
(270) 842-0383
Fax
(270) 842-0485
NPI assigned
Feb 12, 2007
Last updated
Sep 21, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2018

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

Authorized official

Name
Dr. John N. Breiwa, O.D.NPI 1659392207
Title
President
Phone
(270) 842-0383

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

335 New Towne Rd
Bowling Green, KY 42103-7966

Mailing address

P.O. Box 5000
335 New Towne Drive
Bowling Green, KY 42103-7966
Phone (270) 842-0383

Other identifiers 2

IdentifierTypeStateIssuer
7100253310MedicaidKY
06622OtherKYSPECTERA

Other names 1

  • Vison Source of Bowling Green Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051117000034 KY Part B Supplier - Clinic/Group Practice 7517986722 Receives reassigned benefits from 5 practitioners
Practice locations: Bowling Green, KY

National Provider Directory

National Provider Directory

Locations

335 New Towne Dr
Bowling Green, KY 42103
Phone (270) 842-0383

1598 Old Gallatin Rd
#B
Scottsville, KY 42164
Phone (270) 237-5434

1598B Gallatin Rd
Scottsville, KY 42164
Phone (270) 237-5434

Practitioners & affiliated clinicians

Practitioners 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537488000000",
    "number": "1841331691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 5000",
            "address_2": "335 NEW TOWNE DRIVE",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037966",
            "telephone_number": "270-842-0383",
            "fax_number": "270-842-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "335 NEW TOWNE RD",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421037966",
            "telephone_number": "270-842-0383",
            "fax_number": "270-842-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREIWA WARE & JESKIE PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2018-09-21",
        "status": "A",
        "authorized_official_last_name": "BREIWA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "N.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "270-842-0383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100253310",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA",
            "identifier": "06622",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vison Source of Bowling Green",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Vison Source of Bowling Green",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.