BRODHEAD VISION
NPI 1164416236
Optometrist in Brodhead, WI
About Brodhead Vision NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BRODHEAD VISION (NPI 1164416236) is a healthcare organization registered as an optometrist in Brodhead, Wisconsin and active in the NPI registry since September 2005. The organization lists Douglas Kelley, Owner/od, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Other Identifiers 8
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Brodhead Vision is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Brodhead Vision, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Brodhead Vision Clinic, Inc's NPI number?
The NPI number for Brodhead Vision Clinic, Inc is 1164416236. It was assigned to this organization in the NPPES registry on September 6, 2005. The provider is doing business as Brodhead Vision.
Where is Brodhead Vision Clinic, Inc located?
Brodhead Vision Clinic, Inc is located at 1005 17th Street, Brodhead, WI 53520. The listed phone number is (608) 897-2128.
What is Brodhead Vision Clinic, Inc's specialty?
The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.
Is Brodhead Vision Clinic, Inc enrolled in Medicare?
Yes. Brodhead Vision Clinic, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Brodhead Vision Clinic, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Optometry) reassigns their Medicare billing to Brodhead Vision Clinic, Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Brodhead Vision Clinic, Inc accept?
Health plans from Dean Health Plan and Quartz list Brodhead Vision Clinic, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Brodhead Vision Clinic, Inc was last updated on October 8, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Brodhead Vision · NPI 1164416236
Optometrist organization in Brodhead, Wisconsin. Organization record, active in the CMS NPPES registry since September 6, 2005.
## Identity
- **NPI:** 1164416236 (Entity type: Organization)
- **Enumerated:** September 6, 2005
- **Primary specialty:** Optometrist · taxonomy 152W00000X
- **Legal business name:** Brodhead Vision Clinic, Inc
- **Organization subpart:** No
- **Authorized official:** Douglas Kelley, OWNER/OD
## Practice location
- **Address:** 1005 17TH STREET, Brodhead, WI 53520
- **Phone:** (608) 897-2128 · **Fax:** (608) 897-3937
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Optometry) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 8, 2014
- **Other identifiers:** Medicare UPIN T63036 (WI); Medicare ID-Type Unspecified 000047153 (WI); Other PHYSICIANS PLUS (WI); and 5 more
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Source: [NPI Profile](https://npiprofile.com/npi/1164416236) · Data from the CMS NPPES public registry.