Provider Demographics
NPI:1346989977
Name:SORENSEN, BRADEN JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADEN
Middle Name:JAMES
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 S GREEN VALLEY PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-0438
Mailing Address - Country:US
Mailing Address - Phone:702-889-3937
Mailing Address - Fax:
Practice Address - Street 1:680 S GREEN VALLEY PKWY STE 120
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-0438
Practice Address - Country:US
Practice Address - Phone:702-889-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist