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General NPI Number Information
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NPI Number | 1548885924
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Entity Type | Organization
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Legal Business Name | BRODIE AND WARGO VISON AND SENSORY THERAPY CENTER LLC
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Dates
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Enumeration Date | 06/11/2020
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Last Update Date | 11/25/2020
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Provider Practice Location Address
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Address Line | 840 W BOUNDARY ST STE 3
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City | PERRYSBURG
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State | OH
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Zip | 43551-1702
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Country | US
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Telephone | 419-215-8428
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Fax |
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Provider Business Mailing Address
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Address Line | 840 W BOUNDARY ST STE 3
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City | PERRYSBURG
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State | OH
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Zip | 43551-1702
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Country | US
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Telephone | 419-215-8428
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KYLE BRODIE
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Credential |
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Telephone | 419-367-9959
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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 |
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License Number State |
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