NPIMap

Organization Active NPI

Bradley J Blumenstock OD, PC

  • Health Service Clinic/Center
  • Lincoln, NE
National Provider Identifier
1962906537
Registry record updated Mar 28, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Service Clinic/CenterTaxonomy code 261QH0100X
License
1106 Issued in NE
Legal business name
BRADLEY J BLUMENSTOCK OD, PC
Doing business as
Blumenstock Family Eyecare
Practice address
1501 Pine Lake Rd Ste 1
Lincoln, NE 68512-3692
Phone
(402) 421-7773
Fax
(402) 421-7859
NPI assigned
Mar 20, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2018

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

Authorized official

Name
Dr. Bradley J Blumenstock, OD, PCNPI 1487716395
Title
Optometrist
Phone
(402) 421-7773

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
Health Service Clinic/Center 261QH0100X 1106 NE Primary

Addresses

Primary practice location

1501 Pine Lake Rd Ste 1
Lincoln, NE 68512-3692

Mailing address

1501 Pine Lake Rd Ste 1
Lincoln, NE 68512-3692
Phone (402) 421-7773

Other identifiers 1

IdentifierTypeStateIssuer
10026719300MedicaidNE

Other names 1

  • Blumenstock Family Eyecare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180419000800 NE Part B Supplier - Clinic/Group Practice 3678836947 Receives reassigned benefits from 3 practitioners
Practice locations: Lincoln, NE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1521504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1522195200000",
    "number": "1962906537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 PINE LAKE RD STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685123692",
            "telephone_number": "402-421-7773",
            "fax_number": "402-421-7859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PINE LAKE RD STE 1",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685123692",
            "telephone_number": "402-421-7773",
            "fax_number": "402-421-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRADLEY J BLUMENSTOCK OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-20",
        "last_updated": "2018-03-28",
        "status": "A",
        "authorized_official_last_name": "BLUMENSTOCK",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "402-421-7773",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD, PC"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "NE",
            "license": "1106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10026719300",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blumenstock Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Blumenstock Family Eyecare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; 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.