Healthcare Provider Details

I. General information

NPI: 1841545225
Provider Name (Legal Business Name): BRENT THORNTON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W 1ST ST
GRIMES IA
50111-4919
US

IV. Provider business mailing address

6627 HAMPTON CT
JOHNSTON IA
50131-2985
US

V. Phone/Fax

Practice location:
  • Phone: 515-986-2821
  • Fax:
Mailing address:
  • Phone: 712-261-1915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002556
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: