Provider Demographics
NPI:1194864868
Name:BRAUTIGAM & SCHNIBBE O DS P S
Entity Type:Organization
Organization Name:BRAUTIGAM & SCHNIBBE O DS P S
Other - Org Name:BROADWAY EYECARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:BRAUTIGAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD, PS
Authorized Official - Phone:509-928-1212
Mailing Address - Street 1:12121 E BROADWAY AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4972
Mailing Address - Country:US
Mailing Address - Phone:509-928-1212
Mailing Address - Fax:509-924-5035
Practice Address - Street 1:12121 E BROADWAY AVE STE 1
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4972
Practice Address - Country:US
Practice Address - Phone:509-928-1212
Practice Address - Fax:509-924-5035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2014-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00000930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADG8772OtherRAILROAD GROUP
WA1003882226OtherNPI - DALE SCHNIBBE
WA1467428458OtherNPI- RICHARD G. BRAUTIGAM
WA410006929OtherRAILROAD MEDICARE
WADG8772OtherPTAN
WADG8772OtherPTAN
WAG319210300Medicare PIN