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General NPI Number Information
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NPI Number | 1659659456
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Entity Type | Organization
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Legal Business Name | BROOKFIELD VISION CARE, LLC
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Dates
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Enumeration Date | 07/27/2011
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Last Update Date | 05/22/2012
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Provider Practice Location Address
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Address Line | 246 FEDERAL RD SUITE C-12
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City | BROOKFIELD
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State | CT
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Zip | 06804-2647
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Country | US
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Telephone | 203-775-1209
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Fax | 203-740-8151
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Provider Business Mailing Address
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Address Line | 246 FEDERAL RD SUITE C-12
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City | BROOKFIELD
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State | CT
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Zip | 06804-2647
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Country | US
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Telephone | 203-775-1209
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Fax | 203-740-8151
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAMELA S SCHRAMM
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Credential | OD
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Telephone | 203-775-1209
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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 | CT2788
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License Number State | CT
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