Provider Demographics
NPI:1790314557
Name:BRADY, KIRSTEN (OD)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FAIRFIELD ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-1666
Mailing Address - Country:US
Mailing Address - Phone:248-515-3341
Mailing Address - Fax:
Practice Address - Street 1:10 FAIRFIELD ST APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-1666
Practice Address - Country:US
Practice Address - Phone:248-515-3341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MATAXONOMY152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist