Provider Demographics
NPI:1891986121
Name:OXANDALE, BRETT MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:MICHAEL
Last Name:OXANDALE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 SW GAGE CENTER DR
Mailing Address - Street 2:SUITE #126
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1655
Mailing Address - Country:US
Mailing Address - Phone:785-273-6717
Mailing Address - Fax:
Practice Address - Street 1:4123 SW GAGE CENTER DR
Practice Address - Street 2:SUITE #126
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604-1655
Practice Address - Country:US
Practice Address - Phone:785-273-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1787152W00000X
MO2007018525152W00000X
NE1280152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist