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NPI Code Detail

MEDICARE: DR. SCOTT W BRASE O.D.

MEDICARE:  DR. SCOTT W BRASE  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
1152W00000XOptometrist3687WA

General Provider Information

NPI Number : 1265516074
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SCOTT W BRASE O.D.
Provider Business Mailing Address
First Line : 164 WINSLOW WAY W
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-2512
Country : US
Telephone Number : 206-842-2015
Fax Number : 206-842-3047
Provider Business Practice Location Address
First Line : 164 WINSLOW WAY W
Second Line :
City : BAINBRIDGE ISLAND
State : WA
Zip : 98110-2512
Country : US
Telephone Number : 206-842-2015
Fax Number : 206-842-3047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2006
Last Update Date : 07/08/2007

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Directions to “ DR. SCOTT W BRASE O.D.” Practice Location

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