Organization
BRONDSTATERS OPTICAL AMERICA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PHILIP BRADFORD BRONDSTATER (PRESIDENT)
(304) 263-2020
Entity
Organization
Contact information
Practice address
800 FOXCROFT AVENUE, SUITE 914, MARTINSBURG, WV 25401
(304) 263-2020
(304) 263-2935
Mailing address
800 FOXCROFT AVENUE, SUITE 914, MARTINSBURG, WV 25401
(304) 263-2020
(304) 263-2935
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16784
AVESIS
WV
01
—
338639
CLARITY VISION
WV
05
—
3810002980
—
WV
01
—
501161
NVA
WV
01
—
VA0031
EYE MED
WV
01
—
WV10170
VBA
WV
Enumeration date
09/28/2006
Last updated
08/22/2020
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