Provider Demographics
NPI:1639151699
Name:BRAVEMAN, BRIAN D (OD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BRAVEMAN
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 1:1177 PROVIDENCE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-278-5535
Mailing Address - Fax:781-440-7411
Practice Address - Street 1:1177 PROVIDENCE HIGHWAY
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-278-5535
Practice Address - Fax:781-440-7411
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2213103OtherFIRST HEALTH
61209OtherFALLON COMMUNITY HEALTH P
7985576OtherAETNA US HEALTHCARE
0335096OtherMEDICAID WELFARE
042472266OtherTRICARE CHAMPUS
042472266OtherTHREE RIVERS
1692125OtherCIGNA PAL ID
787397OtherMVP HEALTH CARE
AA2356OtherHARVARD PILGRIM HEALTHCAR
W16360OtherBLUE SHIELD INDEMNITY
W17040OtherMEDICARE B
042472266OtherHEALTHCARE VALUE MANAGEME
042472266OtherONE HEALTH PLAN
042472266OtherPRIVATE HEALTHCARE SYSTEM
49575OtherCHILDRENS MEDICAL SECURIT
W16360OtherBLUE CARE ELECT
410045266OtherRAILROAD MEDICARE
W16360OtherBLUE SHIELD HMO BLUE
042472266OtherTRICARE CHAMPUS
W16360OtherBLUE SHIELD INDEMNITY