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General NPI Number Information
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NPI Number | 1790907202
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Entity Type | Organization
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Legal Business Name | BETHANY L BREMER OD LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 04/25/2013
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Provider Practice Location Address
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Address Line | 101 N. CONGRESS AVE
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City | LAKE PARK
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State | FL
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Zip | 33403
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Country | US
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Telephone | 561-881-8006
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Fax |
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Provider Business Mailing Address
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Address Line | 101 N CONGRESS AVE
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City | LAKE PARK
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State | FL
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Zip | 33403-3804
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Country | US
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Telephone |
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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. BETHANY L. BREMER
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Credential |
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Telephone | 561-881-8006
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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 | 2606
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License Number State | FL
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