MEDICARE: BROOK RUN VISION CENTER

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
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1235344045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOK RUN VISION CENTER

Provider Business Mailing Address
First Line	:	9335 CHAMBERLAYNE RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2805
Country	:	US
Telephone Number	:	804-264-2956
Fax Number	:

Provider Business Practice Location Address
First Line	:	9335 CHAMBERLAYNE RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2805
Country	:	US
Telephone Number	:	804-264-2956
Fax Number	:	804-267-0447

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL P GRAY
Credential	:	OD
Telephone Number	:	804-264-2956

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	02/15/2023

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Directions to “BROOK RUN VISION CENTER ” Practice Location

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