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General NPI Number Information
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NPI Number | 1649320706
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Entity Type | Individual
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Provider Name | BRENDA HEIKE MONTECALVO O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 02/20/2008
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Provider Practice Location Address
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Address Line | 4248 INDIAN RIPPLE RD
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City | DAYTON
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State | OH
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Zip | 45440-3280
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Country | US
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Telephone | 937-320-0300
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Fax | 937-320-0500
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Provider Business Mailing Address
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Address Line | 4248 INDIAN RIPPLE RD
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City | DAYTON
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State | OH
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Zip | 45440-3280
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Country | US
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Telephone | 937-320-0300
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Fax | 937-320-0500
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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 | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 4167 T795
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License Number State | OH
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