Provider Demographics
NPI:1528344314
Name:SCOTT M BRAUN OD PLLC
Entity type:Organization
Organization Name:SCOTT M BRAUN OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:LINKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-452-4056
Mailing Address - Street 1:901 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7848
Mailing Address - Country:US
Mailing Address - Phone:360-452-4056
Mailing Address - Fax:360-457-1686
Practice Address - Street 1:901 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7848
Practice Address - Country:US
Practice Address - Phone:360-452-4056
Practice Address - Fax:360-457-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1466TX332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6622650001Medicare NSC