Provider Demographics
NPI:1417207069
Name:BRONAUGH OPTICIANS
Entity Type:Organization
Organization Name:BRONAUGH OPTICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BRONAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-632-1010
Mailing Address - Street 1:1607 W FRANK AVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1607 W FRANK AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3103
Practice Address - Country:US
Practice Address - Phone:936-632-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDR4118156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty