Provider Demographics
NPI:1114067659
Name:BRIGHTON OPTICAL, INC.
Entity Type:Organization
Organization Name:BRIGHTON OPTICAL, INC.
Other - Org Name:PEARLE VISION FRANCHISE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BIRCHMEIER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:810-227-2424
Mailing Address - Street 1:8491 W GRAND RIVER AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-4326
Mailing Address - Country:US
Mailing Address - Phone:810-227-2424
Mailing Address - Fax:810-227-5430
Practice Address - Street 1:8491 W GRAND RIVER AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-4326
Practice Address - Country:US
Practice Address - Phone:810-227-2424
Practice Address - Fax:810-227-5430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002516332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4908130001Medicare NSC
MI0N78880Medicare PIN