Provider Demographics
NPI:1376141549
Name:BRAMHALL-DVORAK, CASSANDRA (OD)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:BRAMHALL-DVORAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CASSANDRA
Other - Middle Name:
Other - Last Name:DVORAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 207293
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-7293
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:
Practice Address - Street 1:1300 BROADWAY
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66508-1821
Practice Address - Country:US
Practice Address - Phone:785-562-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-11
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty