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General NPI Number Information
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NPI Number | 1689266066
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Entity Type | Organization
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Legal Business Name | BRIGHTON OPTOMETRY SERVICES LLC
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Dates
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Enumeration Date | 02/08/2021
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 970 GEHRINGER DR
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City | FOWLERVILLE
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State | MI
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Zip | 48836-8622
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Country | US
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Telephone | 517-715-1002
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 463
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City | BRIGHTON
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State | MI
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Zip | 48116-0463
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Country | US
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Telephone | 248-330-9478
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARIE GANNON
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Credential | OD
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Telephone | 248-330-9478
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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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