Provider Demographics
NPI:1821093311
Name:BRAME, CORY LYNNE (MD)
Entity Type:Individual
Prefix:
First Name:CORY
Middle Name:LYNNE
Last Name:BRAME
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR
Mailing Address - Street 2:STE 307
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7829
Mailing Address - Country:US
Mailing Address - Phone:949-721-0800
Mailing Address - Fax:949-721-9676
Practice Address - Street 1:4300 LONG BEACH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2008
Practice Address - Country:US
Practice Address - Phone:562-591-7700
Practice Address - Fax:562-591-1311
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2024-02-27
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAA74973207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A749730OtherBLUE SHIELD
CA00A749730OtherBLUE SHIELD
CAH37999Medicare UPIN