Broadway Vision Source, Incorporated is a medicare enrolled "Optometrist" provider in Eagle Grove, Iowa. Their current practice location is
300 W Broadway St, Eagle Grove, Iowa. You can reach out to their office (for appointments etc.) via phone at
(515) 448-3813.
Broadway Vision Source, Incorporated is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Broadway Vision Source, Incorporated
is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1710456249.
Healthcare Provider's Profile
| Full Name | Broadway Vision Source, Incorporated |
|---|
| Type | Facility |
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| Speciality | Optometrist |
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| Location | 300 W Broadway St, Eagle Grove, Iowa |
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| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1710456249
- Provider Enumeration Date: 11/14/2018
- Last Update Date: 11/14/2018
Medicare PECOS Information:
- PECOS PAC ID: 9537405279
- Enrollment ID: O20190116003137
Medical Identifiers
Medical identifiers for Broadway Vision Source, Incorporated such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1710456249 | NPI | - | NPPES |
| 1346620432 | Other | IA | INDIVIDUAL NPI |
| 1346620432 | Medicaid | IA | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 152W00000X | Optometrist | (* (Not Available)) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works.
Broadway Vision Source, Incorporated acts as a billing entity for following providers:
| Provider Name | Brandon Steven Hauck |
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| Provider Type | Practitioner - Optometry |
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| Provider Identifiers | NPI Number: 1346620432
PECOS PAC ID: 9739492216
Enrollment ID: I20150714000847 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Broadway Vision Source, Incorporated is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Broadway Vision Source, Incorporated
300 W Broadway St, P.o Box 459,
Eagle Grove, IA 50533-1712
Ph: (515) 448-3813 | Broadway Vision Source, Incorporated
300 W Broadway St,
Eagle Grove, IA 50533-1712
Ph: (515) 448-3813 |
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