MEDICARE: BROOKNEAL OPTICAL, INC

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	1101002145	VA

General Provider Information

NPI Number	:	1285667469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKNEAL OPTICAL, INC

Provider Business Mailing Address
First Line	:	207 E. RUSH STREET
Second Line	:	P.O. BOX 100
City	:	BROOKNEAL
State	:	VA
Zip	:	24528-0100
Country	:	US
Telephone Number	:	434-376-3937
Fax Number	:	434-376-3937

Provider Business Practice Location Address
First Line	:	207 E. RUSH STREET
Second Line	:
City	:	BROOKNEAL
State	:	VA
Zip	:	24528-0100
Country	:	US
Telephone Number	:	434-376-3937
Fax Number	:	434-376-3937

Authorized Official
Title or Position	:	PRESIDENT/REGISTERED OPTICAL
Name	:	MR. MARK ALAN KRAMER
Credential	:	R.O.
Telephone Number	:	434-821-0268

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	08/22/2020

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Directions to “BROOKNEAL OPTICAL, INC ” Practice Location

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