Provider Demographics
NPI:1235237512
Name:BRAUN, SHANE RONALD (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:RONALD
Last Name:BRAUN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:5166 SOUTHWOOD LN SW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55902-1846
Mailing Address - Country:US
Mailing Address - Phone:507-358-6275
Mailing Address - Fax:507-292-1731
Practice Address - Street 1:25 25TH ST SE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55904-5554
Practice Address - Country:US
Practice Address - Phone:507-292-1729
Practice Address - Fax:507-292-1731
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU76193Medicare UPIN