Provider Demographics
NPI:1003992694
Name:BROOKSHIRE, BARBRA BRIGITTE (OD)
Entity Type:Individual
Prefix:
First Name:BARBRA
Middle Name:BRIGITTE
Last Name:BROOKSHIRE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BARBRA
Other - Middle Name:BRIGITTE
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2736 15TH ST S
Mailing Address - Street 2:UNIT D
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5968
Mailing Address - Country:US
Mailing Address - Phone:701-282-5880
Mailing Address - Fax:701-282-8414
Practice Address - Street 1:3902 13TH AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3357
Practice Address - Country:US
Practice Address - Phone:701-282-5880
Practice Address - Fax:701-282-8414
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist