MEDICARE: MR. ERICH BREUNIG 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	OEG000221	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BR866567	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1992761720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERICH BREUNIG OD

Provider Business Mailing Address
First Line	:	952 PENLLYN PIKE
Second Line	:
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-0000
Country	:	US
Telephone Number	:	215-628-8799
Fax Number	:	215-628-8798

Provider Business Practice Location Address
First Line	:	952 PENLLYN PIKE
Second Line	:
City	:	SPRING HOUSE
State	:	PA
Zip	:	19477-0000
Country	:	US
Telephone Number	:	215-628-8799
Fax Number	:	215-628-8798

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	02/03/2011

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