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General NPI Number Information
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NPI Number | 1306998919
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Entity Type | Individual
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Provider Name | BRENDA DANI SMOKE O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 400 E FRONT ST STE A
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City | BUCHANAN
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State | MI
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Zip | 49107-1403
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Country | US
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Telephone | 269-695-3434
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Fax | 269-695-2656
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Provider Business Mailing Address
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Address Line | 400 E FRONT ST STE A
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City | BUCHANAN
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State | MI
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Zip | 49107-1403
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Country | US
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Telephone | 269-695-3434
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Fax | 269-695-2656
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4901003315
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License Number State | MI
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