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General NPI Number Information
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NPI Number | 1982757480
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Entity Type | Organization
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Legal Business Name | DR CHARLES J BRAZEAL P C
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 950 HIGHWAY 431 STE 4
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City | ROANOKE
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State | AL
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Zip | 36274-7314
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Country | US
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Telephone | 334-863-2221
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Fax | 334-863-2319
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Provider Business Mailing Address
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Address Line | 950 HIGHWAY 431 STE 4
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City | ROANOKE
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State | AL
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Zip | 36274-7314
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Country | US
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Telephone | 334-863-2221
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Fax | 334-863-2319
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. DAWN NORTON
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Credential |
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Telephone | 334-863-2221
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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 | S407TA017
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License Number State | AL
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