TARA BRACKLEY (NPI# 1144633702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144633702 |
| Entity Type | Individual |
| Full Name | TARA BRACKLEY |
| Credential | OD |
| Practice Address |
4000 Medical Center Dr Suite 207 Fayetteville NY 13066-6631 |
| Mailing Address |
6221 State Route 31 Suite 104 Cicero NY 13039-8715 |
| Practice Telephone | 3156371010 |
| Practice Fax Number | 3156372010 |
| Mailing Telephone | 3157520141 |
| Mailing Fax Number | 3157520142 |
| Enumeration Date | 2014-06-11 |
| Last Update Date | 2014-06-11 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | TUV008116 | NY | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | NYS LICENSE | TUV008116 | 01 |
| Street Address |
4000 MEDICAL CENTER DR SUITE 207 |
| City | FAYETTEVILLE |
| State | NY |
| Zip Code | 13066-6631 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154322519 | Gerard S Rodziewicz | Neurological Surgery | 4000 Medical Center Dr, Suite 108, Fayetteville, NY 13066-6631 | 2005-08-09 |
| 1992131973 | Adam W Paddock | Physician Assistant | 4000 Medical Center Dr, Fayetteville, NY 13066-6631 | 2013-09-23 |
| 1548570807 | Eastside Audiology Services, LLC | Audiologist | 4000 Medical Center Dr, Suite 404, Fayetteville, NY 13066-6631 | 2010-10-20 |
| 1003035494 | Rui Wang | Acupuncturist | 4000 Medical Center Dr, Suite 209, Fayetteville, NY 13066-6631 | 2007-04-24 |
| 1619011715 | William Tucker Md Pllc | Ophthalmology | 4000 Medical Center Dr, Suite 207, Fayetteville, NY 13066-6631 | 2007-02-20 |
| 1689733974 | Cny Spine Medicine, Pllc | Physician Assistant | 4000 Medical Center Dr, Ste 4217, Fayetteville, NY 13066-6631 | 2006-12-06 |
| 1730273806 | William M Tucker | Ophthalmology | 4000 Medical Center Dr, Suite 207, Fayetteville, NY 13066-6631 | 2006-10-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457819963 | Word Wellness Center, LLC | Psychologist | 6836 E Genesee Street, Suite A, Fayetteville, NY 13066 | 2019-03-05 |
| 1629529060 | Lorna Boyer Chase | Marriage & Family Therapist | 109 White Heron Circle, Fayetteville, NY 13066 | 2016-10-20 |
| 1699221432 | Roman Batyuk | Nurse Practitioner | 4100 Medical Center Drive, Fayetteville, NY 13066 | 2016-08-31 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1013375328 | Kristin Kukenberger | Chiropractor | 7000 E Genesee St Bldg B, Fayetteville, NY 13066 | 2016-02-01 |
| 1124394671 | Susan Hartman Brenizer | Marriage & Family Therapist | 7000 E Genesee St Lyndon Office Park, Bldg. A, Second Floor (upper Level), Fayetteville, NY 13066 | 2012-03-29 |
| 1245541432 | Rene L Converse | Occupational Therapist | 7200 E. Genesee Street, Fayetteville, NY 13066 | 2010-06-23 |
| 1689815805 | Menorah Park Group Residents | Clinic/Center | 12 Jamar Drive, Dewitt, NY 13066 | 2009-03-18 |
| 1063677458 | John Marcena Glezen | Obstetrics & Gynecology | 1 The Gazebo, Fayetteville, NY 13066 | 2008-07-24 |
| 1629232418 | Tucker Martin Harris | Otolaryngology | 4000 Medical Center Dr # 117, Fayetteville, NY 13066 | 2008-07-11 |
| Find all providers in zip 13066 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679103220 | Atl Optical LLC | Optometrist | 1135 Highway 85 N Ste D, Fayetteville, GA 30214-2085 | 2020-01-23 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1922515808 | Focused Family Eye Care, Pllc | Optometrist | 3730 N Vantage Dr, Fayetteville, AR 72703-5442 | 2018-01-02 |
| 1952829186 | Davis Eye Associates Inc. | Optometrist | 2901 E Zion Rd Ste 13, Fayetteville, AR 72703-5070 | 2017-09-08 |
| 1427405133 | National Eye Care, Inc | Optometrist | 5160 Kinloch Circle, Fayetteville, NY 13066 | 2016-05-23 |
| 1356730493 | Myeyedr Optometry of North Carolina, Pllc | Optometrist | 326 Glensford Dr, Suite 108, Fayetteville, NC 28314 | 2015-01-13 |
| 1013314608 | Ashley Ballard | Optometrist | 326 Glensford Dr Ste 108, Fayetteville, NC 28314-3219 | 2014-11-25 |
| 1891108924 | Focus Vision Optometric Care, Pllc | Optometrist | 1594 Skibo Rd, Fayetteville, NC 28303-3478 | 2014-06-06 |
| 1336488204 | Northwest Vision Group | Optometrist | 3215 E Summershade Dr, Fayetteville, AR 72703-4375 | 2013-02-12 |
| 1912257247 | Zachary Robert Engle | Optometrist | 419 Cross Creek Mall, Ste 302, Fayetteville, NC 28303-7285 | 2012-09-13 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 13066 |
Please comment or provide details below to improve the information on TARA BRACKLEY.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.