Active NPI
Michael Wesley Broome, O.D.
- Optometrist
- Evans, GA
National Provider Identifier
1841604220
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPT002823
- Practice address
- 510 N Belair Rd
Evans, GA 30809-3105 - Phone
- (706) 863-3030
- Fax
- (706) 863-0093
- NPI assigned
- Jun 13, 2014
- Last updated
- Jul 21, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPT002823 | GA | Primary |
Addresses
Primary practice location
510 N Belair Rd
Evans, GA 30809-3105
Mailing address
510 N Belair Rd
Evans, GA 30809-3105
Phone (706) 863-3030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Southern College of Optometry, 2014
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
510 N Belair Rd
Evans, GA 30809-3105
Phone (706) 863-3030
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPT002823 | GA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyecare One Martinez LLC | Optometrist | Current | Accepting new patients |
Locations
510 N Belair Rd
Evans, GA 30809
Phone (706) 863-3030
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1402617600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405900800000",
"number": "1841604220",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 N BELAIR RD",
"city": "EVANS",
"state": "GA",
"postal_code": "308093105",
"telephone_number": "706-863-3030",
"fax_number": "706-863-0093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 N BELAIR RD",
"city": "EVANS",
"state": "GA",
"postal_code": "308093105",
"telephone_number": "706-863-3030",
"fax_number": "706-863-0093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOME",
"first_name": "MICHAEL",
"middle_name": "WESLEY",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-06-13",
"last_updated": "2014-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "GA",
"license": "OPT002823",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Evans, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2014; 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.