Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 1815 | WA |
NPI | 1245365519 |
---|---|
Provider Name | Dr. Joseph Wallace Braun |
First Address | Spokane, WA 99223-3000 |
Second Address | Spokane, WA 99207-1406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U01636 | (02) |