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General NPI Number Information
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NPI Number | 1174672489
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Entity Type | Organization
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Legal Business Name | ERNEST B. BRAZINA, O. D. INC.
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 23150 LORAIN RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-1620
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Country | US
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Telephone | 440-716-1330
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Fax | 440-779-9685
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Provider Business Mailing Address
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Address Line | 23150 LORAIN RD
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City | NORTH OLMSTED
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State | OH
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Zip | 44070-1620
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Country | US
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Telephone | 440-716-1330
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Fax | 440-779-9685
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNEST B. BRAZINA
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Credential | O. D.
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Telephone | 440-716-1330
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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 | 3397 T003
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License Number State | OH
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