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General NPI Number Information
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NPI Number | 1437330446
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Entity Type | Organization
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Legal Business Name | ROBERT M. BRENNER O.D.
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 08/24/2010
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Provider Practice Location Address
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Address Line | 70 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44902-1624
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Country | US
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Telephone | 419-525-1207
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Fax | 419-525-0030
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Provider Business Mailing Address
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Address Line | 70 PARK AVE W
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City | MANSFIELD
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State | OH
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Zip | 44902-1624
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Country | US
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Telephone | 419-525-1207
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Fax | 419-525-0030
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT M. BRENNER
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Credential | O.D.
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Telephone | 419-525-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 3398
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License Number State | OH
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