Provider Demographics
NPI:1588666382
Name:BRAGNO, JAMES F (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:BRAGNO
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 1:1700 MCHENRY AVE
Mailing Address - Street 2:SUITE 77
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4373
Mailing Address - Country:US
Mailing Address - Phone:209-524-4626
Mailing Address - Fax:
Practice Address - Street 1:1700 MCHENRY AVE
Practice Address - Street 2:SUITE 77
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4373
Practice Address - Country:US
Practice Address - Phone:209-524-4626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA05133T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA942178998OtherTAX ID #
CAT09878Medicare UPIN
CASD0051330Medicare ID - Type Unspecified