Provider Demographics
NPI:1124033782
Name:BREMNER, ERIN TROY (OD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:TROY
Last Name:BREMNER
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 1:38 E HARVEY ST
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1240
Mailing Address - Country:US
Mailing Address - Phone:218-365-4919
Mailing Address - Fax:218-365-7770
Practice Address - Street 1:38 E HARVEY ST
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1240
Practice Address - Country:US
Practice Address - Phone:218-365-4919
Practice Address - Fax:218-365-7770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2959152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5207080001Medicare NSC
MNV00152Medicare UPIN