Provider Demographics
NPI:1740223866
Name:BRASWELL, DAVID R (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:BRASWELL
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 1:819 TIFFANY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1812
Mailing Address - Country:US
Mailing Address - Phone:252-972-2020
Mailing Address - Fax:252-977-7241
Practice Address - Street 1:819 TIFFANY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1812
Practice Address - Country:US
Practice Address - Phone:252-972-2020
Practice Address - Fax:252-977-7241
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0913BOtherBCBSNC PROVIDER ID
NC890913BMedicaid
NC890913BMedicaid
NC0913BOtherBCBSNC PROVIDER ID