Provider Demographics
NPI:1124146360
Name:SZIROVECZ, BRENDA WEIRICH (OD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:WEIRICH
Last Name:SZIROVECZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:BRENDA
Other - Middle Name:
Other - Last Name:WEIRICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2435 HAMPTONS PSGE
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-7411
Mailing Address - Country:US
Mailing Address - Phone:404-663-3723
Mailing Address - Fax:
Practice Address - Street 1:1154 NORTHPOINT CIR
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-4854
Practice Address - Country:US
Practice Address - Phone:770-667-8060
Practice Address - Fax:770-667-2024
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52530089001OtherBLUE CROSS BLUE SHIELD
GA147484Medicare ID - Type Unspecified
GA52530089001OtherBLUE CROSS BLUE SHIELD