Provider Demographics
NPI:1518013515
Name:BRAHM'S OPTICIANS OF OLDE TOWNE
Entity Type:Organization
Organization Name:BRAHM'S OPTICIANS OF OLDE TOWNE
Other - Org Name:BRAHM & POWELL GUILD OPTICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERTIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-549-2828
Mailing Address - Street 1:113 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3022
Mailing Address - Country:US
Mailing Address - Phone:703-549-2828
Mailing Address - Fax:703-549-7872
Practice Address - Street 1:113 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3022
Practice Address - Country:US
Practice Address - Phone:703-549-2828
Practice Address - Fax:703-549-7872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2887401332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier