Provider Demographics
NPI:1154756831
Name:ERIC BRAUCH OD, PA
Entity type:Organization
Organization Name:ERIC BRAUCH OD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-898-1930
Mailing Address - Street 1:3805 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7004
Mailing Address - Country:US
Mailing Address - Phone:305-898-1930
Mailing Address - Fax:305-821-3159
Practice Address - Street 1:3805 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7004
Practice Address - Country:US
Practice Address - Phone:305-898-1930
Practice Address - Fax:305-821-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620399000Medicaid
FL620399001Medicaid
FL620399002Medicaid
FL620399002Medicaid