Individual
THOMAS G. BRELAGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
206 W JOHN FITCH AVE, BARDSTOWN, KY 40004-1115
(502) 348-1107
(502) 348-0294
Mailing address
206 W JOHN FITCH AVE, BARDSTOWN, KY 40004-1115
(502) 348-1107
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
934DT
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050702
ANTHEM
KY
01
—
1103277
PASSPORT
KY
05
—
77009348
—
KY
01
—
911185
BLOCK VISION
KY
Enumeration date
07/21/2006
Last updated
11/21/2013
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