Provider Demographics
NPI:1821441221
Name:ATHENA BRASFIELD OD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ATHENA BRASFIELD OD A PROFESSIONAL CORPORATION
Other - Org Name:COACHELLA VALLEY OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ATHENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-347-6636
Mailing Address - Street 1:PO BOX 5040
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92248-5040
Mailing Address - Country:US
Mailing Address - Phone:760-347-6636
Mailing Address - Fax:844-833-6644
Practice Address - Street 1:82227 US HIGHWAY 111 STE B2
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5668
Practice Address - Country:US
Practice Address - Phone:760-347-6636
Practice Address - Fax:844-833-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13362 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty