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NPI Code Detail

MEDICARE: ROBERT EDWARD BROMM O.D.

MEDICARE: ROBERT EDWARD BROMM O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist18001664AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
118001664BOTHERINOLDPAC
218001664AOTHERININDIANA LICENSE

General Provider Information

NPI Number : 1083641633
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT EDWARD BROMM O.D.
Provider Business Mailing Address
First Line : 10144 BYRON CT
Second Line :
City : NEWBURGH
State : IN
Zip : 47630-9350
Country : US
Telephone Number : 812-490-0967
Fax Number :
Provider Business Practice Location Address
First Line : 1150 LINCOLN AVE
Second Line :
City : EVANSVILLE
State : IN
Zip : 47714-1071
Country : US
Telephone Number : 812-477-3937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2006
Last Update Date : 07/31/2013

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