MEDICARE: MS. CRYSTAL M BRIMER 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
1	152W00000X	Optometrist	NC1811	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2200298	OTHER	NC	UHC ID #
3	014PA	OTHER	NC	BCBS PROVIDER ID
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	014PA	OTHER	NC	BCBS
6	B8413	OTHER	NC	MEDCOST PROVIDER #

General Provider Information

NPI Number	:	1922189844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CRYSTAL M BRIMER O.D

Provider Business Mailing Address
First Line	:	710 MILITARY CUTOFF ROAD
Second Line	:	SUITE 130
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2382
Country	:	US
Telephone Number	:	910-447-2020
Fax Number	:	866-984-3914

Provider Business Practice Location Address
First Line	:	710 MILITARY CUTOFF ROAD
Second Line	:	SUITE 130
City	:	WILMINGTON
State	:	NC
Zip	:	28405-2382
Country	:	US
Telephone Number	:	910-447-2020
Fax Number	:	866-984-3914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	05/12/2023

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