Provider Demographics
NPI:1679003420
Name:HUME, BRENT MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:MICHAEL
Last Name:HUME
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:PSC 836 BOX 2670
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09636-9998
Mailing Address - Country:US
Mailing Address - Phone:317-627-4101
Mailing Address - Fax:
Practice Address - Street 1:95121 VILLAGGIO DEGLI ULIVI
Practice Address - Street 2:
Practice Address - City:SIGONELLA
Practice Address - State:CATANIA
Practice Address - Zip Code:09636
Practice Address - Country:IT
Practice Address - Phone:317-627-4101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004023152W00000X
IN18004023A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist