Provider Demographics
NPI:1417903261
Name:BROM, JAMES T (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:T
Last Name:BROM
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:PO BOX 963
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-0963
Mailing Address - Country:US
Mailing Address - Phone:606-836-8153
Mailing Address - Fax:606-834-9420
Practice Address - Street 1:2135 ARGILLITE RD
Practice Address - Street 2:
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-1629
Practice Address - Country:US
Practice Address - Phone:606-836-8153
Practice Address - Fax:606-834-9420
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0927DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000050261OtherBLUE CROSS BLUE SHIELD
KY77009272Medicaid
KY00814001Medicare PIN
KY9237501Medicare PIN
KYT54725Medicare UPIN
KY77009272Medicaid
KY0579800001Medicare NSC
KYDP9231Medicare PIN