Provider Demographics
NPI:1699884411
Name:CORY LYNNE BRAME MD INC
Entity type:Organization
Organization Name:CORY LYNNE BRAME MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:LYNNE
Authorized Official - Last Name:BRAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-721-0800
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7853
Mailing Address - Country:US
Mailing Address - Phone:949-721-0800
Mailing Address - Fax:949-721-9676
Practice Address - Street 1:360 SAN MIGUEL DR
Practice Address - Street 2:SUITE 307
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7853
Practice Address - Country:US
Practice Address - Phone:949-721-0800
Practice Address - Fax:949-721-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W16730Medicare ID - Type Unspecified