Provider Demographics
NPI:1144374265
Name:BRENT OPTICAL INC
Entity type:Organization
Organization Name:BRENT OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEMPSIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-944-7144
Mailing Address - Street 1:312 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4066
Mailing Address - Country:US
Mailing Address - Phone:814-944-7144
Mailing Address - Fax:
Practice Address - Street 1:312 ORCHARD AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4066
Practice Address - Country:US
Practice Address - Phone:814-944-7144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA07105017332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA283248OtherHIGHMARK
PA393534OtherNVA
PA393534OtherNVA