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General NPI Number Information
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NPI Number | 1336861889
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Entity Type | Individual
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Provider Name | TAYLOR BROOKE RUNYON OD
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Gender | Female
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Dates
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Enumeration Date | 09/12/2022
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 2625 NASHVILLE RD
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City | BOWLING GREEN
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State | KY
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Zip | 42101-4098
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Country | US
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Telephone | 270-781-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 343 WINNERS CIR
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City | GLASGOW
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State | KY
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Zip | 42141-8012
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Country | US
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Telephone | 270-646-8875
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Fax |
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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 | 2291DT
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License Number State | KY
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