Provider Demographics
NPI:1033541099
Name:BRONSON EYE CARE, L.L.C
Entity Type:Organization
Organization Name:BRONSON EYE CARE, L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRONSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-837-6847
Mailing Address - Street 1:692 W RANDALL ST
Mailing Address - Street 2:
Mailing Address - City:COOPERSVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49404
Mailing Address - Country:US
Mailing Address - Phone:616-837-6847
Mailing Address - Fax:616-837-9338
Practice Address - Street 1:692 W RANDALL ST
Practice Address - Street 2:
Practice Address - City:COOPERSVILLE
Practice Address - State:MI
Practice Address - Zip Code:49404
Practice Address - Country:US
Practice Address - Phone:616-837-6847
Practice Address - Fax:616-837-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003997152W00000X
MI49010030937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5330000441Medicare NSC
MIMI7082Medicare PIN
MIOD17845Medicare PIN