Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3682 | WI |
NPI | 1013585611 |
---|---|
Provider Name | Hailee R Brayton |
First Address | Sheboygan, WI 53081-3129 |
Second Address | Sheboygan, WI 53081-3129 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2021 |
Last Update Date | 24/11/2021 |