MEDICARE: NANETTE BRISBANE, O.D., PLLC

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

General Provider Information

NPI Number	:	1700217403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NANETTE BRISBANE, O.D., PLLC

Provider Business Mailing Address
First Line	:	12209 E MISSION AVE STE 9
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4824
Country	:	US
Telephone Number	:	509-443-3145
Fax Number	:	509-443-3968

Provider Business Practice Location Address
First Line	:	12209 E MISSION AVE STE 9
Second Line	:
City	:	SPOKANE VALLEY
State	:	WA
Zip	:	99206-4824
Country	:	US
Telephone Number	:	509-443-3145
Fax Number	:	509-443-3968

Authorized Official
Title or Position	:	OWNER / OPTOMETRIST
Name	:	NANETTE M BRISBANE
Credential	:	OD
Telephone Number	:	509-443-3145

Provider Enumeration Date	:	12/05/2013
Last Update Date	:	07/21/2022

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