Provider Demographics
NPI:1407052533
Name:ECKENRODE, BRENDA J (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:J
Last Name:ECKENRODE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 RANGER LN
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16613-7607
Mailing Address - Country:US
Mailing Address - Phone:814-674-2640
Mailing Address - Fax:
Practice Address - Street 1:130 RANGER LN
Practice Address - Street 2:
Practice Address - City:ASHVILLE
Practice Address - State:PA
Practice Address - Zip Code:16613-7607
Practice Address - Country:US
Practice Address - Phone:814-674-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2009-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist