Healthcare Provider Details

I. General information

NPI: 1124033782
Provider Name (Legal Business Name): ERIN TROY BREMNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 E HARVEY ST
ELY MN
55731-1240
US

IV. Provider business mailing address

38 E HARVEY ST
ELY MN
55731-1240
US

V. Phone/Fax

Practice location:
  • Phone: 218-365-4919
  • Fax: 218-365-7770
Mailing address:
  • Phone: 218-365-4919
  • Fax: 218-365-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2959
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: