1982617379 NPI number — EDWARD T BRAJDIC O.D.

Table of content: EDWARD T BRAJDIC O.D. (NPI 1982617379)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982617379 NPI number — EDWARD T BRAJDIC O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAJDIC
Provider First Name:
EDWARD
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1982617379
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1225 S MAIN ST
Provider Second Line Business Mailing Address:
SUITE 403
Provider Business Mailing Address City Name:
GREENSBURG
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15601-5370
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-838-7361
Provider Business Mailing Address Fax Number:
724-838-7362

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1225 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 403
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15601-5370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-838-7361
Provider Business Practice Location Address Fax Number:
724-838-7362
Provider Enumeration Date:
08/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG-000661 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 49795 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: OEG-000661 . This is a "OPTOMETRY LICENSE NO." identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 301437 . This is a "NVA" identifier . This identifiers is of the category "OTHER".
  • Identifier: T30344 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0009041800001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 424494 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 77790 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 810224 . This is a "EYEMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 910224 . This is a "EYEMED-2ND LOCATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 301437 . This is a "UPMC HEALTH PLAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com