Provider Demographics
NPI:1073685145
Name:BROCWELL, CHRISTOPHER BRADLEY (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRADLEY
Last Name:BROCWELL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CRYSTAL POINT DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4170
Mailing Address - Country:US
Mailing Address - Phone:614-361-1774
Mailing Address - Fax:
Practice Address - Street 1:7990 SPRINGBORO PIKE
Practice Address - Street 2:
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3706
Practice Address - Country:US
Practice Address - Phone:937-433-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4916152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH48626OtherDAVIS VISION
OH152221OtherCOLE VISION
OH03638OtherSPECTERA
OH152221OtherCOLE VISION