Brandon Phillip Malmstadt

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD61565990 Issued in WA

Practice address

950 11TH Ave
Longview, WA 98632-2504

Phone

(360) 244-1808

NPI assigned

Mar 7, 2023

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Aeg Washington Professional PC

  • Optometrist
  • Bellevue, WA
  • NPI 1134835176
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720310400000",
    "number": "1962102947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 345",
            "city": "RIDGEFIELD",
            "state": "WA",
            "postal_code": "986420345",
            "telephone_number": "360-244-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 11TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322504",
            "telephone_number": "360-244-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALMSTADT",
        "first_name": "BRANDON",
        "middle_name": "PHILLIP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-07",
        "last_updated": "2024-07-07",
        "certification_date": "2024-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD61565990",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jayden Makinson
• Lacey Makinson
• Praise Malabag
• David Maligro, PA-C
• Katie Malloy, M.S.
• Jennifer L Malone-Dieter, AAC
• Aimee Gwyn Mamich, PMHNP-BC, MSN, RN
• Ramnish Jagdish Mandrelle, MBBS, MD
• Herbert Mao, DO
• Steven G Marandas, DMD

• Optometrist in Longview, WA
• Providers in Longview, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2024; 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.

Verify at the official NPI Registry.