Healthcare Provider Details

I. General information

NPI: 1205839453
Provider Name (Legal Business Name): DR. THOMAS B BRUMLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3509 BRIARFIELD BLVD
MAUMEE OH
43537-9383
US

IV. Provider business mailing address

3509 BRIARFIELD BLVD
MAUMEE OH
43537-9383
US

V. Phone/Fax

Practice location:
  • Phone: 419-865-3866
  • Fax: 419-865-3451
Mailing address:
  • Phone: 419-865-3866
  • Fax: 419-865-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License Number35-03-0075
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35-03-0075
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: