Provider Demographics
NPI:1427107416
Name:BRENNY, WILLIAM L (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:L
Last Name:BRENNY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 N CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON
Mailing Address - State:IA
Mailing Address - Zip Code:50129-1906
Mailing Address - Country:US
Mailing Address - Phone:515-386-3513
Mailing Address - Fax:515-465-5373
Practice Address - Street 1:207 N CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:IA
Practice Address - Zip Code:50129-1906
Practice Address - Country:US
Practice Address - Phone:515-386-3513
Practice Address - Fax:515-465-5373
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152 01612152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2131557Medicaid
IAT00828Medicare UPIN
IA2131557Medicaid