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General NPI Number Information
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NPI Number | 1154756831
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Entity Type | Organization
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Legal Business Name | ERIC BRAUCH OD, PA
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 3805 W 16TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-7004
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Country | US
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Telephone | 305-898-1930
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Fax | 305-821-3159
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Provider Business Mailing Address
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Address Line | 3805 W 16TH AVE
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City | HIALEAH
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State | FL
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Zip | 33012-7004
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Country | US
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Telephone | 305-898-1930
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Fax | 305-821-3159
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | ERIC BRAUCH
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Credential | O.D.
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Telephone | 305-898-1930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3201
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License Number State | FL
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