Provider Demographics
NPI:1851878748
Name:ROMAN, BRANDI SHAYNE (OD)
Entity Type:Individual
Prefix:
First Name:BRANDI
Middle Name:SHAYNE
Last Name:ROMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:BRANDI
Other - Middle Name:SHAYNE
Other - Last Name:DAUGHERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8135 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6244
Mailing Address - Country:US
Mailing Address - Phone:330-758-0900
Mailing Address - Fax:
Practice Address - Street 1:400 BUTLER CMNS
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2496
Practice Address - Country:US
Practice Address - Phone:724-256-9966
Practice Address - Fax:724-256-9984
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003443152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist