MEDICARE: DR. BRETT H MUNN OD

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	152W00000X	Optometrist	1264	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336118215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRETT H MUNN OD

Provider Business Mailing Address
First Line	:	902 W MAIN ST
Second Line	:	P.O. BOX 1757
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-679-2931
Fax Number	:	336-677-6486

Provider Business Practice Location Address
First Line	:	902 W MAIN ST
Second Line	:
City	:	YADKINVILLE
State	:	NC
Zip	:	27055-7807
Country	:	US
Telephone Number	:	336-679-2931
Fax Number	:	336-677-6486

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	07/08/2007

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