Provider Demographics
NPI:1093169310
Name:BRAVE OPTICAL INC
Entity Type:Organization
Organization Name:BRAVE OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-402-4423
Mailing Address - Street 1:6579 MOUNTAIN SKY RD
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1306
Mailing Address - Country:US
Mailing Address - Phone:214-402-4423
Mailing Address - Fax:
Practice Address - Street 1:1713 PRESTON RD
Practice Address - Street 2:STE A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5283
Practice Address - Country:US
Practice Address - Phone:214-402-4423
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier