Individual
MICHAEL STEVEN BROOKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
302 N HARTH AVENUE, MADISON, SD 57042
(605) 256-6911
(605) 256-9017
Mailing address
PO BOX 388, MADISON, SD 57042-0388
(605) 256-6911
(605) 256-9017
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1533TX
WA
152W00000X
Optometrist
1626
OR
152W00000X
Optometrist
Primary
T507
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9202922
—
SD
Enumeration date
08/04/2006
Last updated
11/30/2009
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