Provider Demographics
NPI:1598363624
Name:CHRISTOPHER W BRACKETT OD LLC
Entity Type:Organization
Organization Name:CHRISTOPHER W BRACKETT OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-589-8018
Mailing Address - Street 1:4405 BELLEMEADE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0682
Mailing Address - Country:US
Mailing Address - Phone:812-474-1010
Mailing Address - Fax:
Practice Address - Street 1:4405 BELLEMEADE AVE STE 101
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0682
Practice Address - Country:US
Practice Address - Phone:812-474-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN231380AMedicaid