Healthcare Provider Details

I. General information

NPI: 1417903261
Provider Name (Legal Business Name): JAMES T BROM OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 02/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2135 ARGILLITE RD
FLATWOODS KY
41139-1629
US

IV. Provider business mailing address

PO BOX 963
FLATWOODS KY
41139-0963
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-8153
  • Fax: 606-834-9420
Mailing address:
  • Phone: 606-836-8153
  • Fax: 606-834-9420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0927DT
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: