Provider Demographics
NPI:1336118215
Name:MUNN, BRETT H (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:H
Last Name:MUNN
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 1:902 W MAIN ST
Mailing Address - Street 2:P.O. BOX 1757
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-7807
Mailing Address - Country:US
Mailing Address - Phone:336-679-2931
Mailing Address - Fax:336-677-6486
Practice Address - Street 1:902 W MAIN ST
Practice Address - Street 2:
Practice Address - City:YADKINVILLE
Practice Address - State:NC
Practice Address - Zip Code:27055-7807
Practice Address - Country:US
Practice Address - Phone:336-679-2931
Practice Address - Fax:336-677-6486
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7909627Medicaid
NCT65110Medicare UPIN
NC7909627Medicaid