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General NPI Number Information
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NPI Number | 1255635348
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Entity Type | Organization
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Legal Business Name | ANNETTE BRABHAM OD PA
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Dates
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Enumeration Date | 01/04/2011
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Last Update Date | 06/17/2013
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Provider Practice Location Address
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Address Line | 111 N JOHN SIMS PKWY
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City | VALPARAISO
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State | FL
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Zip | 32580-1005
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Country | US
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Telephone | 850-729-8711
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Fax | 850-729-8713
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Provider Business Mailing Address
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Address Line | 111 N JOHN SIMS PKWY
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City | VALPARAISO
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State | FL
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Zip | 32580-1005
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Country | US
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Telephone | 850-729-8711
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Fax | 850-729-8713
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Authorized Official
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Title or Position | OWNER/DOCTOR
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Name | DR. ANNETTE BRABHAM
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Credential | O.D
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Telephone | 850-729-8711
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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 | OP0002698
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License Number State | FL
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