MEDICARE: DR. ROBERT MAURICE BRENNER 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	3398	OH

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	:	1689629206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT MAURICE BRENNER OD

Provider Business Mailing Address
First Line	:	70 PARK AVE WEST
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44902
Country	:	US
Telephone Number	:	419-525-1207
Fax Number	:	419-525-0030

Provider Business Practice Location Address
First Line	:	70 PARK AVE W
Second Line	:
City	:	MANSFIELD
State	:	OH
Zip	:	44902-1624
Country	:	US
Telephone Number	:	419-525-1207
Fax Number	:	419-525-0030

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	06/23/2011

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