Healthcare Provider Details

I. General information

NPI: 1891986121
Provider Name (Legal Business Name): BRETT MICHAEL OXANDALE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4123 SW GAGE CENTER DR SUITE #126
TOPEKA KS
66604-1655
US

IV. Provider business mailing address

4123 SW GAGE CENTER DR SUITE #126
TOPEKA KS
66604-1655
US

V. Phone/Fax

Practice location:
  • Phone: 785-273-6717
  • Fax:
Mailing address:
  • Phone: 785-273-6717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1787
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2007018525
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1280
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: