Healthcare Provider Details

I. General information

NPI: 1386693117
Provider Name (Legal Business Name): CATHY LYNN BRASWELL O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6479 WINCHESTER RD
MEMPHIS TN
38115-4257
US

IV. Provider business mailing address

289 RICHBRIAR ST
MEMPHIS TN
38120-1825
US

V. Phone/Fax

Practice location:
  • Phone: 901-365-9732
  • Fax: 901-375-9005
Mailing address:
  • Phone: 901-680-8220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1377
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: