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NPI Code Detail

MEDICARE: DR. KENNETH EDWARD BROOKMAN O.D.

MEDICARE: DR. KENNETH EDWARD BROOKMAN 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
1152W00000XOptometrist5509TPACA

General Provider Information

NPI Number : 1932292828
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH EDWARD BROOKMAN O.D.
Provider Business Mailing Address
First Line : 2575 YORBA LINDA BLVD
Second Line : YORBA LINDA
City : FULLERTON
State : CA
Zip : 92831-1615
Country : US
Telephone Number : 714-449-7498
Fax Number : 714-992-7871
Provider Business Practice Location Address
First Line : 2575 YORBA LINDA BLVD
Second Line : YORBA LINDA
City : FULLERTON
State : CA
Zip : 92831-1615
Country : US
Telephone Number : 714-449-7498
Fax Number : 714-992-7871
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2006
Last Update Date : 07/08/2007

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