Provider Demographics
NPI:1679212864
Name:BRILLHART, MADELINE ANN (OD)
Entity Type:Individual
Prefix:DR
First Name:MADELINE
Middle Name:ANN
Last Name:BRILLHART
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:327 CONCORD CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9488
Mailing Address - Country:US
Mailing Address - Phone:740-575-6946
Mailing Address - Fax:
Practice Address - Street 1:1935 BLUEGRASS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1181
Practice Address - Country:US
Practice Address - Phone:502-364-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2271DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist