Individual
CHARDA P BRONAUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
1607 W FRANK AVE, SUITE 109, LUFKIN, TX 75904-3103
(936) 632-1010
(936) 632-3233
Mailing address
1607 W FRANK AVE, SUITE 109, LUFKIN, TX 75904-3103
(936) 632-1010
(936) 632-3233
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
086517201
—
TX
Enumeration date
05/06/2006
Last updated
12/15/2009
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