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General NPI Number Information
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NPI Number | 1952365702
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Entity Type | Individual
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Provider Name | JOHN L BRINKLEY OD
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Gender | Male
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Dates
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Enumeration Date | 04/17/2006
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Last Update Date | 03/11/2014
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Provider Practice Location Address
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Address Line | 360 HARBISON BLVD
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City | COLUMBIA
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State | SC
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Zip | 29212-2248
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Country | US
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Telephone | 803-732-8663
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Fax |
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Provider Business Mailing Address
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Address Line | 119 LATONEA DR
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City | COLUMBIA
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State | SC
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Zip | 29210-7572
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Country | US
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Telephone | 803-798-8642
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Fax | 803-798-0422
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 656
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 152WV0400X
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Taxonomy Name | Vision Therapy Optometrist
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License Number | 656
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 656
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License Number State | SC
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