Broadway Vision Source, Incorporated
NPI 1710456249ActiveOrganization· Optometrist· Eagle Grove, IA
Optometrist in Eagle Grove, Iowa, registered in NPPES in November 2018, part of Broadway Vision Source, Incorporated. The authorized official on file is Brandon S. Hauck, O.D, Owner. Enrolled in Medicare as dme supplier - physician - optometrist and part b supplier - clinic/group practice.
Overview
| NPI | 1710456249 |
|---|---|
| Status | Active |
| Entity type | Organization (subpart) |
| Parent organization | Broadway Vision Source, Incorporated |
| NPI issued | Nov 14, 2018 |
| Last updated in NPPES | Nov 14, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Optometrist Primary | 152W00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled DME Supplier - Physician - Optometrist (IA); Part B Supplier - Clinic/Group Practice (IA) |
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