Organization Active NPI

Optometric Center of Charles City PC

  • Optometrist
  • Charles City, IA
National Provider Identifier
1972596732
Registry record updated Jun 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OPTOMETRIC CENTER OF CHARLES CITY PC
Practice address
800 Clark St
Charles City, IA 50616-2218
Phone
(641) 228-1732
Fax
(641) 228-2434
NPI assigned
Aug 26, 2005
Last updated
Jun 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2026

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

Authorized official

Name
Dr. Bradley Jason Ellingson, ODNPI 1598102600
Title
President
Phone
(641) 228-1732

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
Optometrist 152W00000X NU Primary

Addresses

Primary practice location

800 Clark St
Charles City, IA 50616-2218

Mailing address

800 Clark St
Charles City, IA 50616-2218
Phone (641) 228-1732

Other identifiers 1

IdentifierTypeStateIssuer
0458463MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040406001243 IA Part B Supplier - Clinic/Group Practice 8022001908 Receives reassigned benefits from 2 practitioners
Practice locations: Charles City, IA
O20100930050490 IA DME Supplier - Physician - Optometrist 8022001908 Practice locations: Charles City, IA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
The Optometric Center of Charles Ci800 Clark St, Charles City, IA 50616-2218(641) 228-1732 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1125014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782432000000",
    "number": "1972596732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 CLARK ST",
            "city": "CHARLES CITY",
            "state": "IA",
            "postal_code": "506162218",
            "telephone_number": "641-228-1732",
            "fax_number": "641-228-2434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 CLARK ST",
            "city": "CHARLES CITY",
            "state": "IA",
            "postal_code": "506162218",
            "telephone_number": "641-228-1732",
            "fax_number": "641-228-2434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTOMETRIC CENTER OF CHARLES CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-26",
        "last_updated": "2026-06-26",
        "certification_date": "2026-06-26",
        "status": "A",
        "authorized_official_last_name": "ELLINGSON",
        "authorized_official_first_name": "BRADLEY",
        "authorized_official_middle_name": "JASON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "641-228-1732",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0458463",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charles City, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.