Provider Demographics
NPI:1154353746
Name:BRAXTON, DONALD EUGENE (OD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:EUGENE
Last Name:BRAXTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 311619
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31131-1619
Mailing Address - Country:US
Mailing Address - Phone:770-852-1002
Mailing Address - Fax:770-947-9893
Practice Address - Street 1:2451 CUMBERLAND PKWY SE
Practice Address - Street 2:STE. 3138
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6136
Practice Address - Country:US
Practice Address - Phone:770-852-1002
Practice Address - Fax:770-947-9893
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001375152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management