1184881732 NPI number — BRONAUGH INDEPENDENT OPTICIANS INC.

Table of content: (NPI 1184881732)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184881732 NPI number — BRONAUGH INDEPENDENT OPTICIANS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRONAUGH INDEPENDENT OPTICIANS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184881732
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 GASLIGHT BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUFKIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75904-3167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-632-1010
Provider Business Mailing Address Fax Number:
936-632-3233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 GASLIGHT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUFKIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75904-3167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-632-1010
Provider Business Practice Location Address Fax Number:
936-632-3233
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BRONAUGH
Authorized Official First Name:
CHARDA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CORPORATE PRESIDENT
Authorized Official Telephone Number:
936-632-1010

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 80112 . This is a "AVESIS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 925101 . This is a "BLOCK VISION OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0906860002 . This is a "TRS ACTIVCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 908788 . This is a "BLOCK VISION OF TEXAS INC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086517201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5090961 . This is a "CONNECTICUT GENERAL LIFE INSURANCE CO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 0906860002 . This is a "TRICARE HUMANA MILITARY HEALTHCARE SERVICES" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 0906860002 . This is a "SUPERIOR VISION SERVICES INC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 4007229 . This is a "BLUE CROSS BLUE SHIELD OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 504262 . This is a "BLUE CROSS BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: OP1740 . This is a "EYEMED VISION CARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 32603 . This is a "OPTICARE MANAGED VISION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0906860002 . This is a "AMERITAS LIFE INSURANCE CORP" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 0005524399 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com