Individual provider Active NPI

Calen Bruner, OD

  • Optometrist
  • Greenville, OH
National Provider Identifier
1992444269
Registry record updated Jun 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
T7074 Issued in OH
Practice address
5164 Childrens Home Bradford Rd
Greenville, OH 45331-9327
Phone
(937) 548-7811
NPI assigned
Jun 3, 2022
Last updated
Jun 3, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X T7074 OH Primary

Addresses

Primary practice location

5164 Childrens Home Bradford Rd
Greenville, OH 45331-9327

Mailing address

5164 Childrens Home Bradford Rd
Greenville, OH 45331-9327
Phone (937) 548-7811

Medicare participation

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

Enrollment IDStateProvider typePAC IDDetails
I20220718003387 OH Practitioner - Optometry 2961883269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dickman Kettler and Bruner IncGroup PAC ID 1759380694, 6 clinicians

Practice addresses (Care Compare)

5164 Childrens Home Rd
Greenville, OH 45331-9327
Phone (937) 459-5095

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery16

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
T7074OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dickman Kettler & Bruner Inc Optometrist CurrentSince Jun 7, 2022 Accepting new patients
Northwest Optometry LLC Optometrist Past Accepting new patients

Locations

201 S 2nd St
Coldwater, OH 45828
Phone (419) 678-3016

639 W National Rd
Englewood, OH 45322
Phone (937) 836-3041

5164 Childrens Home Rd
Greenville, OH 45331
Phone (937) 316-8155

250 Greenville Rd
Saint Marys, OH 45885
Phone (419) 394-5184

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1654214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654214400000",
    "number": "1992444269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5164 CHILDRENS HOME BRADFORD RD",
            "city": "GREENVILLE",
            "state": "OH",
            "postal_code": "453319327",
            "telephone_number": "937-548-7811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5164 CHILDRENS HOME BRADFORD RD",
            "city": "GREENVILLE",
            "state": "OH",
            "postal_code": "453319327",
            "telephone_number": "937-548-7811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUNER",
        "first_name": "CALEN",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-06-03",
        "last_updated": "2022-06-03",
        "certification_date": "2022-05-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "T7074",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, OH

Sources for this page

Verify at the official NPI Registry.