Organization Active NPI

Berner Eye Clinic, Inc

Doing business as Broadway Eye Clinic

  • Optometrist
  • Salt Lake City, UT
National Provider Identifier
1902889165
Registry record updated Oct 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
BERNER EYE CLINIC, INC
Doing business as
Broadway Eye Clinic
Practice address
250 E 300 S Ste 380
Salt Lake City, UT 84111-2428
Phone
(801) 322-0467
Fax
(801) 363-6053
NPI assigned
Nov 22, 2005
Last updated
Oct 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2025

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

Authorized official

Name
Karri A Buresh, ODNPI 1124009824
Title
Owner/Coe
Phone
(801) 322-0467

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

250 E 300 S Ste 380
Salt Lake City, UT 84111-2428

Mailing address

250 E 300 S Ste 380
Salt Lake City, UT 84111-2428
Phone (801) 322-0467

Other identifiers 1

IdentifierTypeStateIssuer
1027390MedicaidUT

Other names 1

  • Broadway Eye Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040626000466 UT Part B Supplier - Clinic/Group Practice 9537145875 Receives reassigned benefits from 5 practitioners
Practice locations: Salt Lake City, UT

National Provider Directory

National Provider Directory

Locations

250 E Broadway
Ste 110
Salt Lake City, UT 84111
Phone (801) 322-0467

250 E Broadway
#A
Salt Lake Cty, UT 84111
Phone (801) 322-0467

250 E Broadway
Salt Lake Cty, UT 84111
Phone (801) 322-0467

250 E Broadway
Ste 380
Slc, UT 84111
Phone (801) 322-0467

Practitioners & affiliated clinicians

Practitioners 6

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": "1132617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1760572800000",
    "number": "1902889165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 E 300 S STE 380",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841112428",
            "telephone_number": "801-322-0467",
            "fax_number": "801-363-6053"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 E 300 S STE 380",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841112428",
            "telephone_number": "801-322-0467",
            "fax_number": "801-363-6053"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BERNER EYE CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-22",
        "last_updated": "2025-10-16",
        "certification_date": "2025-10-16",
        "status": "A",
        "authorized_official_last_name": "BURESH",
        "authorized_official_first_name": "KARRI",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER/COE",
        "authorized_official_telephone_number": "801-322-0467",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1027390",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Broadway Eye Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salt Lake City, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2025; 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.