Organization
BRENT OPTICAL
Active
Other names
Johnston Optical Company
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRENT W. BALKEMA (OWNER)
(616) 458-1951
Entity
Organization
Contact information
Practice address
25 MICHIGAN ST NE, SUITE 1000, GRAND RAPIDS, MI 49503-2561
(616) 458-1951
(616) 458-2089
Mailing address
25 MICHIGAN ST NE, SUITE 1000, GRAND RAPIDS, MI 49503-2561
(616) 458-1951
(616) 458-2089
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0D16535
BCBSM
MI
05
—
943136666
—
MI
Enumeration date
01/24/2006
Last updated
03/30/2009
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