Provider Demographics
NPI:1992761720
Name:BREUNIG, ERICH (OD)
Entity type:Individual
Prefix:MR
First Name:ERICH
Middle Name:
Last Name:BREUNIG
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 1:952 PENLLYN PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRING HOUSE
Mailing Address - State:PA
Mailing Address - Zip Code:19477-0000
Mailing Address - Country:US
Mailing Address - Phone:215-628-8799
Mailing Address - Fax:215-628-8798
Practice Address - Street 1:952 PENLLYN PIKE
Practice Address - Street 2:
Practice Address - City:SPRING HOUSE
Practice Address - State:PA
Practice Address - Zip Code:19477-0000
Practice Address - Country:US
Practice Address - Phone:215-628-8799
Practice Address - Fax:215-628-8798
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000221152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABR866567OtherBLUE CROSS
PA077131SLUMedicare ID - Type Unspecified
PABR866567OtherBLUE CROSS