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General NPI Number Information
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NPI Number | 1417903261
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Entity Type | Individual
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Provider Name | JAMES T BROM OD
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Gender | Male
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 2135 ARGILLITE RD
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City | FLATWOODS
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State | KY
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Zip | 41139-1629
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Country | US
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Telephone | 606-836-8153
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Fax | 606-834-9420
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Provider Business Mailing Address
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Address Line | PO BOX 963
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City | FLATWOODS
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State | KY
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Zip | 41139-0963
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Country | US
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Telephone | 606-836-8153
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Fax | 606-834-9420
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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 | 0927DT
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License Number State | KY
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