Brent Optical

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

BRENT OPTICAL

Practice address

25 Michigan St NE
Suite 1000
Grand Rapids, MI 49503-2561

Phone

(616) 458-1951

Fax

(616) 458-2089

NPI assigned

Jan 24, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Brent W. Balkema

Title

Owner

Phone

(616) 458-1951

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Johnston Optical Company Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1238371200000",
    "number": "1396715199",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE",
            "address_2": "SUITE 1000",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032561",
            "telephone_number": "616-458-1951",
            "fax_number": "616-458-2089"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE",
            "address_2": "SUITE 1000",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032561",
            "telephone_number": "616-458-1951",
            "fax_number": "616-458-2089"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT OPTICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-24",
        "last_updated": "2009-03-30",
        "status": "A",
        "authorized_official_last_name": "BALKEMA",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "W.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-458-1951",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "943136666",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "0D16535",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Johnston Optical Company",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• James B Brennan, D.D.S.
• Lizbeth Brenneman, MA, CCC-SLP
• Anna Brenner, BCBA, LBA
• Jennifer Rebecca Brenner
• Olivia Brenninkmeijer, MA, LPC, NCC
• Mikayla May Brett, OTR
• Thomas James Brettschneider
• Brode Lee Breuker, MD
• Glenn Breuker, OTR/L
• Bethany Christine Brew, PA-C

• Optician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Optician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.