Provider Demographics
NPI:1669486866
Name:BRAATEN, MARCUS RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:RICHARD
Last Name:BRAATEN
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 1:4326 CHARLESTOWN RD # 2
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-8542
Mailing Address - Country:US
Mailing Address - Phone:812-945-0023
Mailing Address - Fax:812-945-0291
Practice Address - Street 1:4326 CHARLESTOWN RD # 2
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-8542
Practice Address - Country:US
Practice Address - Phone:812-945-0023
Practice Address - Fax:812-945-0291
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003432A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300012451Medicaid
IN5928080001Medicare NSC
IN249040AMedicare PIN
IN200844370AMedicaid