| Doctor Name: | MRS. BRENDA L TIBBETTS |
| NPI Number: | 1528361805 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 5499 |
| Business Practice Address: | 170 Main St Ste E Monson, MA - 010571353 |
| Business Phone Number: | 4132674200 |
| Business Fax Number: | 4132674200 |
| Mailing Address: | 170 Main St Ste E, MONSON |
| State: | MA |
| Postal Code: | 010571353 |
| Phone Number: | 4132674200 |
| Fax Number: | 4132674200 |
| NPI Enumeration Date: | 12/08/2010 |
| NPI Last Update Date: | 12/27/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | 5499 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |