Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 05712TG | TX |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 05712TG | TX |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 05712TG | TX |
N | 152WP0200X | Pediatric Optomitrist | 05712TG | TX |
N | 152WS0006X | Sports Vision | 05712TG | TX |
N | 152WV0400X | Optomitrist - Vision Therapist | 05712TG | VT |
N | 152WX0102X | Occupational Vision | 05712TG | TX |
NPI | 1114028883 |
---|---|
Provider Name | James Warren Brasher |
First Address | San Angelo, TX 76904-5521 |
Second Address | San Angelo, TX 76904-5521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80301Q | BLUE CROSS BLUE SHIELD (01) | TN |