Provider Demographics
NPI:1427220805
Name:DR. KENNETH R. BRAUN PA
Entity Type:Organization
Organization Name:DR. KENNETH R. BRAUN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC ASST.
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BRAUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-648-8674
Mailing Address - Street 1:724 RICHLAND AVE W
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29801-3832
Mailing Address - Country:US
Mailing Address - Phone:803-648-8974
Mailing Address - Fax:
Practice Address - Street 1:724 RICHLAND AVE W
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-3832
Practice Address - Country:US
Practice Address - Phone:803-648-8974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4545152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9609Medicaid
SC0441930001Medicare NSC
SCDA9609Medicaid
SCT24912Medicare UPIN