Provider Demographics
NPI:1982129284
Name:BARRY BROBST OPTICAL,LLC
Entity type:Organization
Organization Name:BARRY BROBST OPTICAL,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BROBST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-868-5535
Mailing Address - Street 1:65 E ELIZABETH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:610-868-0612
Practice Address - Street 1:65 E ELIZABETH AVE STE 300
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6506
Practice Address - Country:US
Practice Address - Phone:610-868-5535
Practice Address - Fax:610-868-0612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2017-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty