Active NPI
Brenna Bullock
- Ophthalmology Physician
- Tucson, AZ
National Provider Identifier
1952983801
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- R78566
- Practice address
- 655 N Alvernon Way Ste 204
Tucson, AZ 85711-1825 - Phone
- (248) 444-5331
- NPI assigned
- Apr 21, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | R78566 | AZ | Primary |
Addresses
Primary practice location
655 N Alvernon Way Ste 204
Tucson, AZ 85711-1825
Mailing address
45615 Freemont
Novi, MI 48374-3132
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690934400000",
"number": "1952983801",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "45615 FREEMONT",
"city": "NOVI",
"state": "MI",
"postal_code": "483743132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "655 N ALVERNON WAY STE 204",
"city": "TUCSON",
"state": "AZ",
"postal_code": "857111825",
"telephone_number": "248-444-5331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLOCK",
"first_name": "BRENNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-21",
"last_updated": "2023-08-02",
"certification_date": "2023-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "AZ",
"license": "R78566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucson, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2023; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.