Healthcare Provider Details

I. General information

NPI: 1275730723
Provider Name (Legal Business Name): AARON W BRONNER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E BROOKWOOD DR
EAGLE ID
83616-3891
US

IV. Provider business mailing address

521 E BROOKWOOD DR
EAGLE ID
83616-3891
US

V. Phone/Fax

Practice location:
  • Phone: 208-473-0476
  • Fax:
Mailing address:
  • Phone: 208-473-0476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60284076
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODP100159
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: