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General NPI Number Information
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NPI Number | 1669534095
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Entity Type | Individual
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Provider Name | JEFFREY A BRALICH LDO
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Gender | Male
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Dates
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Enumeration Date | 12/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 116 FEDERAL PLZ W
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City | YOUNGSTOWN
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State | OH
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Zip | 44503-1302
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Country | US
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Telephone | 330-743-5714
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Fax |
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Provider Business Mailing Address
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Address Line | 2024 PARKDALE AVE
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City | HERMITAGE
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State | PA
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Zip | 16148-2228
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Country | US
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Telephone | 724-342-5850
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | SC6087
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License Number State | OH
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