Provider Demographics
NPI:1053479485
Name:BRADEN, MICHAEL R (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:R
Last Name:BRADEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5420 STATE ROUTE 764
Mailing Address - Street 2:
Mailing Address - City:WHITESVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42378-9641
Mailing Address - Country:US
Mailing Address - Phone:270-313-8717
Mailing Address - Fax:270-754-4909
Practice Address - Street 1:1725 W EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1833
Practice Address - Country:US
Practice Address - Phone:270-754-4483
Practice Address - Fax:270-754-4909
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1311DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77013118Medicaid