Provider Demographics
NPI:1922040252
Name:BRANSGROVE & ASSOCIATES PA
Entity Type:Organization
Organization Name:BRANSGROVE & ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRANSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-661-2724
Mailing Address - Street 1:10284 NW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-7967
Mailing Address - Country:US
Mailing Address - Phone:305-661-2724
Mailing Address - Fax:954-575-0000
Practice Address - Street 1:10284 NW 47TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351
Practice Address - Country:US
Practice Address - Phone:305-661-2724
Practice Address - Fax:954-575-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3498Medicare ID - Type UnspecifiedMEDICARE