Active NPI
Rodney L. Middlebrook, O.D.
- Optometrist
- Austin, MN
National Provider Identifier
1962454033
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1743
- Practice address
- 1209 18TH Ave NW
Austin, MN 55912-1881 - Phone
- (507) 437-8228
- NPI assigned
- May 17, 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 | 1743 | MN | Primary |
Addresses
Primary practice location
1209 18TH Ave NW
Austin, MN 55912-1881
Mailing address
1201 19TH St NE
Austin, MN 55912-4115
Phone (507) 433-2257
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 126023500 | Medicaid | MN |
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 |
|---|---|---|---|
| 1743 | MN | MD | Mental Health Counselor |
| 2292 | MN | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147824000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1396224000000",
"number": "1962454033",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 19TH ST NE",
"city": "AUSTIN",
"state": "MN",
"postal_code": "559124115",
"telephone_number": "507-433-2257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1209 18TH AVE NW",
"city": "AUSTIN",
"state": "MN",
"postal_code": "559121881",
"telephone_number": "507-437-8228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIDDLEBROOK",
"first_name": "RODNEY",
"middle_name": "L.",
"name_prefix": "Mr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-17",
"last_updated": "2014-03-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "1743",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "126023500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Austin, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.