Healthcare Provider Details

I. General information

NPI: 1548261746
Provider Name (Legal Business Name): CHRISTOPHER W BRACKETT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4405 BELLEMEADE AVE STE 101
EVANSVILLE IN
47714-0682
US

IV. Provider business mailing address

4405 BELLEMEADE AVE SUITE 101
EVANSVILLE IN
47714-0682
US

V. Phone/Fax

Practice location:
  • Phone: 812-474-1010
  • Fax: 812-485-2476
Mailing address:
  • Phone: 812-474-1010
  • Fax: 812-485-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18003248A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: