Provider Demographics
NPI:1427212539
Name:BREHM, MICHELLE DIANE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DIANE
Last Name:BREHM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:BREHM
Other - Last Name:CHOPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10134 FLINT ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2696
Mailing Address - Country:US
Mailing Address - Phone:913-488-7663
Mailing Address - Fax:
Practice Address - Street 1:2531 N CLARK ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1717
Practice Address - Country:US
Practice Address - Phone:773-281-3560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008019711152W00000X
IL046010307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist