Healthcare Provider Details

I. General information

NPI: 1558478453
Provider Name (Legal Business Name): DICKMAN KETTLER & BRUNER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S 2ND ST
COLDWATER OH
45828-1747
US

IV. Provider business mailing address

PO BOX 95 201 S SECOND ST
COLDWATER OH
45828-0095
US

V. Phone/Fax

Practice location:
  • Phone: 419-678-3016
  • Fax: 419-678-8849
Mailing address:
  • Phone: 419-678-3016
  • Fax: 419-678-8849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: JILLYNN F BRUNER
Title or Position: VICE PRESIDENT
Credential: OD
Phone: 419-678-3016