Provider Demographics
NPI:1043405871
Name:BRONNI, LEANNA (ABOC)
Entity type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:BRONNI
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24452 CHARLES DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2589
Mailing Address - Country:US
Mailing Address - Phone:734-789-8255
Mailing Address - Fax:734-789-8257
Practice Address - Street 1:24452 CHARLES DR
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48183-2589
Practice Address - Country:US
Practice Address - Phone:734-789-8255
Practice Address - Fax:734-789-8257
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician