Provider Demographics
NPI:1194758581
Name:BRONNER, CHERYL (OD)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:
Last Name:BRONNER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 7TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CENTER
Mailing Address - State:IA
Mailing Address - Zip Code:51250-1197
Mailing Address - Country:US
Mailing Address - Phone:720-363-3192
Mailing Address - Fax:
Practice Address - Street 1:714 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:SPENCER
Practice Address - State:IA
Practice Address - Zip Code:51301-5730
Practice Address - Country:US
Practice Address - Phone:712-262-3982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1692152W00000X
IA02040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO638733OtherBCBS PROVIDER NUMBER