Provider Demographics
NPI:1932292828
Name:BROOKMAN, KENNETH EDWARD (OD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:EDWARD
Last Name:BROOKMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2575 YORBA LINDA BLVD
Mailing Address - Street 2:YORBA LINDA
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-1615
Mailing Address - Country:US
Mailing Address - Phone:714-449-7498
Mailing Address - Fax:714-992-7871
Practice Address - Street 1:2575 YORBA LINDA BLVD
Practice Address - Street 2:YORBA LINDA
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-1615
Practice Address - Country:US
Practice Address - Phone:714-449-7498
Practice Address - Fax:714-992-7871
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5509TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist