Provider Demographics
NPI:1649320706
Name:MONTECALVO, BRENDA HEIKE (OD)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:HEIKE
Last Name:MONTECALVO
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 1:4248 INDIAN RIPPLE RD
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3280
Mailing Address - Country:US
Mailing Address - Phone:937-320-0300
Mailing Address - Fax:937-320-0500
Practice Address - Street 1:4248 INDIAN RIPPLE RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3280
Practice Address - Country:US
Practice Address - Phone:937-320-0300
Practice Address - Fax:937-320-0500
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4167 T795152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0869494Medicaid
0869449Medicare UPIN
0716942Medicare PIN