Active NPI
Thomas Howard Berenson, O.D.
- Optometrist
- Broken Arrow, OK
National Provider Identifier
1942280896
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 795
- Practice address
- 3300 S Aspen Ave
Suite D
Broken Arrow, OK 74012-7501 - Phone
- (918) 451-2020
- Fax
- (918) 449-9086
- NPI assigned
- Jan 18, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 795 | OK | Primary |
Addresses
Primary practice location
3300 S Aspen Ave
Suite D
Broken Arrow, OK 74012-7501
Mailing address
3300 S Aspen Ave
Suite D
Broken Arrow, OK 74012-7501
Phone (918) 451-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100765420A | Medicaid | OK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 795 | OK | MD | Hearing Instrument Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137542400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210032000000",
"number": "1942280896",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3300 S ASPEN AVE",
"address_2": "SUITE D",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740127501",
"telephone_number": "918-451-2020",
"fax_number": "918-449-9086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3300 S ASPEN AVE",
"address_2": "SUITE D",
"city": "BROKEN ARROW",
"state": "OK",
"postal_code": "740127501",
"telephone_number": "918-451-2020",
"fax_number": "918-449-9086"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERENSON",
"first_name": "THOMAS",
"middle_name": "HOWARD",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-18",
"last_updated": "2008-05-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OK",
"license": "795",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100765420A",
"state": "OK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Broken Arrow, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.