Healthcare Provider Details

I. General information

NPI: 1114067659
Provider Name (Legal Business Name): BRIGHTON OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/28/2024
Certification Date: 05/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 W GRAND RIVER AVE SUITE 400
BRIGHTON MI
48116-4326
US

IV. Provider business mailing address

8491 W GRAND RIVER AVE SUITE 400
BRIGHTON MI
48116-4326
US

V. Phone/Fax

Practice location:
  • Phone: 810-227-2424
  • Fax: 810-227-5430
Mailing address:
  • Phone: 810-227-2424
  • Fax: 810-227-5430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOHN E BIRCHMEIER
Title or Position: PRESIDENT
Credential: O.D.
Phone: 810-227-2424