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General NPI Number Information
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NPI Number | 1194864868
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Entity Type | Organization
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Legal Business Name | BRAUTIGAM & SCHNIBBE O DS P S
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 12/29/2014
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Provider Practice Location Address
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Address Line | 12121 E BROADWAY AVE STE 1
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4972
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Country | US
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Telephone | 509-928-1212
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Fax | 509-924-5035
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Provider Business Mailing Address
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Address Line | 12121 E BROADWAY AVE STE 1
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City | SPOKANE VALLEY
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State | WA
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Zip | 99206-4972
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Country | US
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Telephone | 509-928-1212
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Fax | 509-924-5035
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Authorized Official
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Title or Position | OWNER OPTOMETRIST
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Name | DR. RICHARD G. BRAUTIGAM
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Credential | O.D., P.S.
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Telephone | 509-928-1212
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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 | OD00000930
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License Number State | WA
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