Provider Demographics
NPI:1104026962
Name:BRASFIELD, ATHENA REYES (OD)
Entity Type:Individual
Prefix:DR
First Name:ATHENA
Middle Name:REYES
Last Name:BRASFIELD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ATHENA
Other - Middle Name:RENEE
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:82227 US HIGHWAY 111 STE B2
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5668
Mailing Address - Country:US
Mailing Address - Phone:760-347-6636
Mailing Address - Fax:760-342-5987
Practice Address - Street 1:82227 US HIGHWAY 111 STE B2
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5668
Practice Address - Country:US
Practice Address - Phone:760-347-6636
Practice Address - Fax:760-342-5987
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13362152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0113621OtherMEDICARE PIN
CASD0113620OtherMEDICARE PIN