Provider Demographics
NPI:1396944195
Name:BRIGHTLIFE DIRECT INC
Entity type:Organization
Organization Name:BRIGHTLIFE DIRECT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELDON
Authorized Official - Middle Name:MAXWELL
Authorized Official - Last Name:BRIGHT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:202-895-6945
Mailing Address - Street 1:4455 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE A-800
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008
Mailing Address - Country:US
Mailing Address - Phone:202-895-6945
Mailing Address - Fax:202-895-6948
Practice Address - Street 1:4455 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE A-800
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008
Practice Address - Country:US
Practice Address - Phone:202-895-6945
Practice Address - Fax:202-895-6948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier