Provider Demographics
NPI:1790810430
Name:BRASS, ELLIOTT JAY (O D)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:JAY
Last Name:BRASS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8086 BEACHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MURRAYVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30564-1618
Mailing Address - Country:US
Mailing Address - Phone:770-364-7024
Mailing Address - Fax:
Practice Address - Street 1:3085 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3353
Practice Address - Country:US
Practice Address - Phone:770-476-3611
Practice Address - Fax:770-476-1921
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA714152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist