MEDICARE: DR. MAYA BRADY O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	27OA00664500	NJ

General Provider Information

NPI Number	:	1104109263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYA BRADY O.D.

Provider Business Mailing Address
First Line	:	722 WALL RD
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2237
Country	:	US
Telephone Number	:	732-735-0377
Fax Number	:

Provider Business Practice Location Address
First Line	:	2018 HIGHWAY 71 STE 1
Second Line	:
City	:	SPRING LAKE
State	:	NJ
Zip	:	07762-2296
Country	:	US
Telephone Number	:	732-359-8080
Fax Number	:	732-359-8383

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2011
Last Update Date	:	06/18/2021

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