MEDICARE: JAMES WARREN BRASHER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	05712TG	TX
2	152WC0802X	Corneal and Contact Management Optometrist	05712TG	TX
3	152WL0500X	Low Vision Rehabilitation Optometrist	05712TG	TX
4	152WP0200X	Pediatric Optometrist	05712TG	TX
5	152WS0006X	Sports Vision Optometrist	05712TG	TX
6	152WV0400X	Vision Therapy Optometrist	05712TG	VT
7	152WX0102X	Occupational Vision Optometrist	05712TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80301Q	OTHER	TN	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1114028883
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WARREN BRASHER O.D.

Provider Business Mailing Address
First Line	:	1721 KNICKERBOCKER RD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5521
Country	:	US
Telephone Number	:	325-944-8531
Fax Number	:	325-944-4213

Provider Business Practice Location Address
First Line	:	1721 KNICKERBOCKER RD
Second Line	:
City	:	SAN ANGELO
State	:	TX
Zip	:	76904-5521
Country	:	US
Telephone Number	:	325-944-8531
Fax Number	:	325-944-4213

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/11/2025

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