Provider Demographics
NPI:1093888711
Name:BRAWDERS, WILLIAM STEVEN (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:STEVEN
Last Name:BRAWDERS
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 1:40033 10TH ST W STE A
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-3016
Mailing Address - Country:US
Mailing Address - Phone:661-265-7515
Mailing Address - Fax:661-265-0883
Practice Address - Street 1:1233 W RANCHO VISTA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3949
Practice Address - Country:US
Practice Address - Phone:661-265-7515
Practice Address - Fax:661-265-0883
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9210T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1869ZMedicare PIN