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General NPI Number Information
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NPI Number | 1508033622
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Entity Type | Organization
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Legal Business Name | DR. WILLIAM F. BRIGHAM, OPTOMETRIST INC
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 05/19/2011
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Provider Practice Location Address
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Address Line | 902 W WAYNE ST
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City | FORT WAYNE
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State | IN
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Zip | 46802-3976
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Country | US
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Telephone | 260-422-9421
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Fax | 260-422-9422
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Provider Business Mailing Address
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Address Line | 902 W WAYNE ST
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City | FORT WAYNE
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State | IN
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Zip | 46802-3976
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Country | US
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Telephone | 260-422-9421
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Fax | 260-422-9422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM F. BRIGHAM
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Credential | OD
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Telephone | 260-422-9421
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 18001470
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 18001470
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License Number State | IN
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