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General NPI Number Information
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NPI Number | 1831485143
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Entity Type | Organization
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Legal Business Name | ROBERT E BRINKER OD,PC
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Dates
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Enumeration Date | 06/24/2011
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Last Update Date | 06/24/2011
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Provider Practice Location Address
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Address Line | 32123 GRATIOT AVE
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City | ROSEVILLE
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State | MI
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Zip | 48066-1147
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Country | US
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Telephone | 586-293-6185
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Fax |
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Provider Business Mailing Address
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Address Line | 55339 BOARDWALK DR
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City | SHELBY TWP
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State | MI
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Zip | 48316-1127
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Country | US
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Telephone | 248-224-9701
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT BRINKER
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Credential |
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Telephone | 248-224-9701
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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 | 4901002898
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License Number State | MI
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