Provider Demographics
NPI:1952586091
Name:BRUNK OPTOMETRY INC
Entity Type:Organization
Organization Name:BRUNK OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BILLY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:BRUNK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-696-6717
Mailing Address - Street 1:816 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:STILWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74960-3453
Mailing Address - Country:US
Mailing Address - Phone:918-696-6717
Mailing Address - Fax:918-696-6717
Practice Address - Street 1:816 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:STILWELL
Practice Address - State:OK
Practice Address - Zip Code:74960-3453
Practice Address - Country:US
Practice Address - Phone:918-696-6717
Practice Address - Fax:918-696-6717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK540012215OtherRAILROAD RETIREMENT BOARD
OK200133770AMedicaid
OKOKB5334Medicare PIN
OK6182960001Medicare NSC
OKT40376Medicare UPIN