Provider Demographics
NPI:1013796937
Name:BROOKS, JOHN (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BROOKS
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 HILTON HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8394
Mailing Address - Country:US
Mailing Address - Phone:434-978-3773
Mailing Address - Fax:
Practice Address - Street 1:975 HILTON HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8394
Practice Address - Country:US
Practice Address - Phone:434-978-3773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician