Provider Demographics
NPI:1093961724
Name:BRAUN, CAROL (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:BRAUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 E OHIO ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3265
Mailing Address - Country:US
Mailing Address - Phone:312-640-2405
Mailing Address - Fax:312-640-6017
Practice Address - Street 1:230 E OHIO ST
Practice Address - Street 2:SUITE 120
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3265
Practice Address - Country:US
Practice Address - Phone:312-640-2405
Practice Address - Fax:312-640-6017
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-13
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.010148152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist