DR. KELLY LYN BRUCH (O.D.) – Optometrist, NPI 1164426078

DR. KELLY LYN BRUCH (O.D.) is a healthcare provider. based in Marion, Ohio. specializing in OPTOMETRY. They hold the professional credentials O.D.. They hold a License No. 5096 (OH). The NPI Number for DR. KELLY LYN BRUCH (O.D.) is 1164426078

Main info

Female
Sole Proprietor
28 Years Of Experience
Accepts Medicare Assignment
Name
DR. KELLY LYN BRUCH (O.D.)
NPI
1164426078
Phone
(740) 389-1300
Address
150 MCMAHAN BLVD
Enumeration Date
8 June 2005
Last Update Date
16 July 2014

Doctor Profile

Medical School Name
INDIANA UNIVERSITY - SCHOOL OF OPTOMETRY
Secondary Phone
7403891300
Graduation Year
1998 (28 years ago)
PAC ID
2961593173
Group Practice PAC ID
3870712961
Professional Enrollment ID
I20070802000153
Address ID
OH433025654MA150XXBLVD300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience54
Completeness75
Years active:21State licenses:1Digital endpointsOther names

1,618 OPTOMETRY in OH

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Provider Addresses for DR. KELLY LYN BRUCH (O.D.)

  • Buckeye Optical, 150, McMahan Boulevard, Marion Township, Marion County, Ohio, 43302, United States

    BUCKEYE OPTICAL

    MARION, OH 433025654

    Phone: (740) 389-1300

    Fax: (740) 389-1335

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-08-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20070802000153IOptometryOHTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 43302)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3870712961View full group profile
NameSpecialtyState
O P T O M E T R YOH
O P T O M E T R YMI

Reviews

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Frequently asked questions

Does DR. KELLY LYN BRUCH (O.D.) share an NPI with anyone else?
NPI numbers are unique to each provider or organization — DR. KELLY LYN BRUCH (O.D.) uses 1164426078.
Is DR. KELLY LYN BRUCH (O.D.) still practicing?
DR. KELLY LYN BRUCH (O.D.) is currently listed as active in the public NPI registry.
What is DR. KELLY LYN BRUCH (O.D.)'s specialty?
The listing groups DR. KELLY LYN BRUCH (O.D.) with Optometrist. Clinical services aligned with this taxonomy classification.
Where should I expect DR. KELLY LYN BRUCH (O.D.) on a map?
Expect Marion, Ohio as a primary anchor for DR. KELLY LYN BRUCH (O.D.) unless the record lists multiple sites.
Why does DR. KELLY LYN BRUCH (O.D.) have multiple addresses?
2 practice locations appear in the available data. Multiple addresses are common for hospital privileges, telehealth, or multi-site groups.

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