Provider Demographics
NPI:1114067659
Name:BRIGHTON OPTICAL, INC.
Entity type:Organization
Organization Name:BRIGHTON OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIRCHMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-227-2424
Mailing Address - Street 1:8491 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4326
Mailing Address - Country:US
Mailing Address - Phone:810-227-2424
Mailing Address - Fax:810-227-5430
Practice Address - Street 1:8491 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4326
Practice Address - Country:US
Practice Address - Phone:810-227-2424
Practice Address - Fax:810-227-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D710430OtherBCBS OF MI
MI0N78880Medicare PIN