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JACOB RICHARD BROMLEY OD
>> Optometrist >> Eye and Vision Services ProvidersRegistrant NPI Number: 1992310312
Individual Registrant: JACOB RICHARD BROMLEY OD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
725 E MAIN ST, APT #1C SOMERTON, AZ 85350 US
Tel: 928-627-4525 Fax: --
Tel: 928-627-4525 Fax: --
Contact information for business:
17439 N 57TH AVE GLENDALE, AZ 85308-3819 US
Tel: 925-708-5301 Fax: --
Tel: 925-708-5301 Fax: --
Registration Information:
NPI: 1992310312
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 152W00000X | Eye and Vision Services Providers Optometrist | AZ | 002462 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
