Provider Demographics
NPI:1003854795
Name:BRANIGAN OPTICAL, INC.
Entity Type:Organization
Organization Name:BRANIGAN OPTICAL, INC.
Other - Org Name:BRANIGAN OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRANIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-569-6600
Mailing Address - Street 1:70 ROYAL PALM PT
Mailing Address - Street 2:SUITE C
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5200
Mailing Address - Country:US
Mailing Address - Phone:772-569-8866
Mailing Address - Fax:772-569-4093
Practice Address - Street 1:70 ROYAL PALM PT
Practice Address - Street 2:SUITE C
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5200
Practice Address - Country:US
Practice Address - Phone:772-569-8866
Practice Address - Fax:772-569-4093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0553100001Medicare ID - Type Unspecified