Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901002417 | MI |
NPI | 1003924572 |
---|---|
Provider Name | Dr. Robert Edward Brichta |
First Address | Hillsdale, MI 49242 |
Second Address | Hillsdale, MI 49242 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 11/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T32846 | (02) |