Provider Demographics
NPI:1174672489
Name:ERNEST B. BRAZINA, O. D. INC.
Entity Type:Organization
Organization Name:ERNEST B. BRAZINA, O. D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRAZINA
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:440-716-1330
Mailing Address - Street 1:23150 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1620
Mailing Address - Country:US
Mailing Address - Phone:440-716-1330
Mailing Address - Fax:440-779-9685
Practice Address - Street 1:23150 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-1620
Practice Address - Country:US
Practice Address - Phone:440-716-1330
Practice Address - Fax:440-779-9685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3397 T003152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty