Organization
GARY T BROTHERSON MD INC
Active
Other names
Niagara Eye Associates
Organization subpart
No
Provider details
NPI number
Authorized official
GARY BROTHERSON MD (PRESIDENT)
(814) 455-8004
Entity
Organization
Contact information
Practice address
1801 W 8TH ST, ERIE, PA 16505-4938
(814) 455-8004
(814) 456-6054
Mailing address
1801 W 8TH ST, ERIE, PA 16505-4938
(814) 455-8004
(814) 456-6054
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OEG001090
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0070886470002
—
PA
01
—
060638
PTAN
PA
01
—
1466887
HIGHMARK MEDICAL
PA
01
—
1942274691
HETRICK NPI
PA
01
—
410040784
MEDICARE RAILROAD
PA
01
—
436660
HETRICK IND HIGHMARLK/VIS
PA
01
—
OEG001090
HETRICK LICENCE
PA
Enumeration date
07/25/2006
Last updated
08/31/2010
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