Provider Demographics
NPI:1598523706
Name:BRENTWOOD EYE CARE
Entity Type:Organization
Organization Name:BRENTWOOD EYE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BRONGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:925-634-6101
Mailing Address - Street 1:350 JOHN MUIR PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5192
Mailing Address - Country:US
Mailing Address - Phone:925-634-6101
Mailing Address - Fax:925-634-1380
Practice Address - Street 1:350 JOHN MUIR PKWY STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5192
Practice Address - Country:US
Practice Address - Phone:925-634-6101
Practice Address - Fax:925-634-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty