Provider Demographics
NPI:1689266066
Name:BRIGHTON OPTOMETRY SERVICES LLC
Entity Type:Organization
Organization Name:BRIGHTON OPTOMETRY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GANNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:248-330-9478
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-0463
Mailing Address - Country:US
Mailing Address - Phone:248-330-9478
Mailing Address - Fax:
Practice Address - Street 1:970 GEHRINGER DR
Practice Address - Street 2:
Practice Address - City:FOWLERVILLE
Practice Address - State:MI
Practice Address - Zip Code:48836-8622
Practice Address - Country:US
Practice Address - Phone:517-715-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIGHTON OPTOMETRY SERVICES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty