Provider Demographics
NPI:1780704643
Name:BROST & ASSOCIATES FAMILY EYE CARE PC
Entity type:Organization
Organization Name:BROST & ASSOCIATES FAMILY EYE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BROST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-334-8595
Mailing Address - Street 1:352 S BROADVIEW ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5703
Mailing Address - Country:US
Mailing Address - Phone:573-334-8595
Mailing Address - Fax:573-334-4143
Practice Address - Street 1:352 S BROADVIEW ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703
Practice Address - Country:US
Practice Address - Phone:573-334-8595
Practice Address - Fax:573-334-4143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507273308Medicaid
MO410037380OtherRAILROAD MEDICARE
MO507273316Medicaid
MO507273316Medicaid
MO0242210001Medicare NSC
MO410037380OtherRAILROAD MEDICARE