# BETHANY L BREMER OD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790907202
- **Authorized official:** DR. BETHANY L. BREMER (OWNER)
- **Authorized official phone:** (561) 881-8006

## Contact information

- **Practice address:** 101 N. CONGRESS AVE, LAKE PARK, FL 33403
- **Practice address phone:** (561) 881-8006
- **Mailing address:** 101 N CONGRESS AVE, LAKE PARK, FL 33403-3804

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | 2606 | FL | Yes |

## Other

- **Enumeration date:** 05/03/2007
- **Last updated:** 04/25/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 621230100 | — | FL |