Provider Demographics
NPI:1538144217
Name:CHARLES A BRIZIUS OD INC
Entity Type:Organization
Organization Name:CHARLES A BRIZIUS OD INC
Other - Org Name:BRIZIUS AND EMBRY
Other - Org Type:Other Name
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:O
Authorized Official - Last Name:EMBRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-477-8696
Mailing Address - Street 1:2700 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-1628
Mailing Address - Country:US
Mailing Address - Phone:812-477-8696
Mailing Address - Fax:812-477-1874
Practice Address - Street 1:2700 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1628
Practice Address - Country:US
Practice Address - Phone:812-477-8696
Practice Address - Fax:812-477-1874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-14
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN56000053A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN56000053AOtherCORPORATION REGISTRATION
INM100019207Medicare PIN
IN56000053AOtherCORPORATION REGISTRATION