Healthcare Provider Details

I. General information

NPI: 1093983496
Provider Name (Legal Business Name): PETER C. BRASCH, MD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 11/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THURBER BLVD
SMITHFIELD RI
02917-1826
US

IV. Provider business mailing address

1 THURBER BLVD
SMITHFIELD RI
02917-1826
US

V. Phone/Fax

Practice location:
  • Phone: 401-349-5360
  • Fax:
Mailing address:
  • Phone: 401-349-5360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: PETER C. BRASCH
Title or Position: OWNER
Credential: M.D.
Phone: 401-487-3963