1518013515 NPI number — BRAHM'S OPTICIANS OF OLDE TOWNE

Table of content: CHRISTI LYN HARRINGTON LCSW (NPI 1548560006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518013515 NPI number — BRAHM'S OPTICIANS OF OLDE TOWNE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRAHM'S OPTICIANS OF OLDE TOWNE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BRAHM & POWELL GUILD OPTICIANS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1518013515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 N WASHINGTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22314-3022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-549-2828
Provider Business Mailing Address Fax Number:
703-549-7872

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
113 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22314-3022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-549-2828
Provider Business Practice Location Address Fax Number:
703-549-7872
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FERTIG
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-549-2828

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  2887401 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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