Provider Demographics
NPI:1386608800
Name:BRAZINA, ERNEST B (OD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:B
Last Name:BRAZINA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23150 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1620
Mailing Address - Country:US
Mailing Address - Phone:440-716-1330
Mailing Address - Fax:440-779-9685
Practice Address - Street 1:23150 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1620
Practice Address - Country:US
Practice Address - Phone:440-716-1330
Practice Address - Fax:440-779-9685
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3397 T003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0397904Medicaid
OHT47081Medicare UPIN
OH0397904Medicaid