Individual provider Active NPI

Brendan Moffat Tobler

  • Optometrist
  • Colorado Springs, CO
National Provider Identifier
1861843203
Registry record updated Jun 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPT.0003216 Issued in CO
Practice address
1130 Lake Plaza Dr
Suite 230
Colorado Springs, CO 80906-3594
Phone
(719) 219-3819
Fax
(719) 219-0411
NPI assigned
Jun 27, 2016
Last updated
Jun 27, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPT.0003216 CO Primary

Addresses

Primary practice location

1130 Lake Plaza Dr
Suite 230
Colorado Springs, CO 80906-3594

Mailing address

1130 Lake Plaza Dr
Suite 230
Colorado Springs, CO 80906-3594
Phone (719) 219-3819

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20170511001450 CO Practitioner - Optometry 4082991401 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bettner Vision, IncGroup PAC ID 3577645050, 2 clinicians

Practice addresses (Care Compare)

9205 N Union Blvd
Suite 110
Colorado Springs, CO 80920-7840
Phone (719) 282-0400

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPT.0003216COMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Bettner Vision, Inc Optometrist CurrentSince Jul 2, 2019 Accepting new patients
Abba Eye Care PC Optometrist CurrentSince Mar 18, 2017 Accepting new patients
Abba Eye Care PC Optometrist CurrentSince Mar 18, 2017 Accepting new patients
Ridgeline Eyecare Associates Optometrist PastSince Jul 2, 2019 Accepting new patients

Locations

2101 Main St
Ste D
Alamosa, CO 81101
Phone (719) 589-2020

1130 Lake Plaza Dr
Ste 130
Colorado Springs, CO 80906
Phone (719) 578-2020

1130 Lake Plaza Dr
Ste 230
Colorado Springs, CO 80906
Phone (719) 219-3819

1813 N Circle Dr
Colorado Springs, CO 80909
Phone (719) 632-2020

4430 N Nevada Ave
Colorado Springs, CO 80907
Phone (719) 635-2020

6220 Woodmen Park Vw
Colorado Springs, CO 80923
Phone (719) 634-2020

9205 N Union Blvd
Ste 110
Colorado Springs, CO 80920
Phone (719) 282-0400

7975 Fountain Mesa Rd
Fountain, CO 80817
Phone (719) 573-2020

420 N Main St
Gunnison, CO 81230
Phone (719) 641-2020

314 Colorado Ave
La Junta, CO 81050
Phone (303) 544-8331

1500 S Main St
Lamar, CO 81052
Phone (719) 336-0417

2800 Cornerstone Dr
Ste A6
Pagosa Springs, CO 81147
Phone (970) 731-4300

1650 W US Highway 50
Pueblo, CO 81008
Phone (719) 542-1222

900 W Northern Ave
Pueblo, CO 81004
Phone (719) 542-2222

Organizations & group practices 4

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": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466985600000",
    "number": "1861843203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 LAKE PLAZA DR",
            "address_2": "SUITE 230",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063594",
            "telephone_number": "719-219-3819",
            "fax_number": "719-219-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 LAKE PLAZA DR",
            "address_2": "SUITE 230",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809063594",
            "telephone_number": "719-219-3819",
            "fax_number": "719-219-0411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TOBLER",
        "first_name": "BRENDAN",
        "middle_name": "MOFFAT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2016-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0003216",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

Verify at the official NPI Registry.