Provider Demographics
NPI:1881761393
Name:BRENART, ROBERT W (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:BRENART
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 E COUNTRYSIDE PKWY
Mailing Address - Street 2:
Mailing Address - City:YORKVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60560-1877
Mailing Address - Country:US
Mailing Address - Phone:630-553-6166
Mailing Address - Fax:630-553-6178
Practice Address - Street 1:120 E COUNTRYSIDE PKWY
Practice Address - Street 2:
Practice Address - City:YORKVILLE
Practice Address - State:IL
Practice Address - Zip Code:60560-1877
Practice Address - Country:US
Practice Address - Phone:630-553-6166
Practice Address - Fax:630-553-6178
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046006926152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046006926Medicaid
IL046006926Medicaid
ILL80108Medicare PIN