Provider Demographics
NPI:1184881732
Name:BRONAUGH INDEPENDENT OPTICIANS INC.
Entity type:Organization
Organization Name:BRONAUGH INDEPENDENT OPTICIANS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRONAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-632-1010
Mailing Address - Street 1:109 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3167
Mailing Address - Country:US
Mailing Address - Phone:936-632-1010
Mailing Address - Fax:936-632-3233
Practice Address - Street 1:109 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3167
Practice Address - Country:US
Practice Address - Phone:936-632-1010
Practice Address - Fax:936-632-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ80112OtherAVESIS
TX925101OtherBLOCK VISION OF TEXAS
TX0906860002OtherTRS ACTIVCARE
TX908788OtherBLOCK VISION OF TEXAS INC
TX086517201Medicaid
CT5090961OtherCONNECTICUT GENERAL LIFE INSURANCE CO
SC0906860002OtherTRICARE HUMANA MILITARY HEALTHCARE SERVICES
CA0906860002OtherSUPERIOR VISION SERVICES INC
TN4007229OtherBLUE CROSS BLUE SHIELD OF TENNESSEE
TX504262OtherBLUE CROSS BLUE SHIELD OF TEXAS
OHOP1740OtherEYEMED VISION CARE
TX32603OtherOPTICARE MANAGED VISION
NE0906860002OtherAMERITAS LIFE INSURANCE CORP
KY0005524399OtherAETNA
OHOP1740OtherEYEMED VISION CARE