Brtva, Dennis M
Brtva, Dennis M is an sole proprietor health care provider with primary practice located at 1015 S Mercer Ave , Bloomington IL 61701-7107. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Brtva, Dennis M can be contacted via phone (309) 213-9200.Contact Information
Primary practice address
1015 S Mercer Ave
Bloomington IL 61701-7107
Phone: (309) 213-9200
Fax: (309) 213-9300
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046-007731 | Illinois |
Profile Details
| NPI number | 1215909056 |
|---|---|
| LBN Legal business name | Brtva, Dennis M |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 6th, 2006 |
| Last updated | Feb 28th, 2022 - about 3 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215909056 | NPPES |
| Illinois | MEDICAID | 046007731 |
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