Provider Demographics
NPI:1689766370
Name:BREUNIG, JENNIFER A (OD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:BREUNIG
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 1:136 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-2609
Mailing Address - Country:US
Mailing Address - Phone:610-489-7800
Mailing Address - Fax:610-489-7988
Practice Address - Street 1:136 2ND AVE
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2609
Practice Address - Country:US
Practice Address - Phone:610-489-7800
Practice Address - Fax:610-489-7988
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA040895Q8VMedicare PIN
PAU81504Medicare UPIN