MEDICARE: LEANNA BRONNI ABOC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician

General Provider Information

NPI Number	:	1043405871
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNA BRONNI ABOC

Provider Business Mailing Address
First Line	:	24452 CHARLES DR
Second Line	:
City	:	BROWNSTOWN
State	:	MI
Zip	:	48183-2589
Country	:	US
Telephone Number	:	734-789-8255
Fax Number	:	734-789-8257

Provider Business Practice Location Address
First Line	:	24452 CHARLES DR
Second Line	:
City	:	BROWNSTOWN
State	:	MI
Zip	:	48183-2589
Country	:	US
Telephone Number	:	734-789-8255
Fax Number	:	734-789-8257

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	09/14/2007

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Directions to “ LEANNA BRONNI ABOC” Practice Location

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