Provider Demographics
NPI:1932117280
Name:BRINDLEY, DENNIS LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:LEE
Last Name:BRINDLEY
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 1:3360 I 75 BUSINESS SPUR
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3605
Mailing Address - Country:US
Mailing Address - Phone:906-635-0861
Mailing Address - Fax:906-635-0581
Practice Address - Street 1:3360 I 75 BUSINESS SPUR
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3605
Practice Address - Country:US
Practice Address - Phone:906-635-0861
Practice Address - Fax:906-635-0581
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI049194001OtherDME
MI5099632Medicaid
MI900A77777OtherBCBS VISION
MI0A77777OtherBCBS MEDICAL
MI5099632Medicaid
0491940001Medicare NSC
MIU24275Medicare UPIN