Provider Demographics
NPI:1205065588
Name:BRADEN, ANDREA K (OD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:K
Last Name:BRADEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5166
Mailing Address - Fax:586-323-4145
Practice Address - Street 1:47670 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3302
Practice Address - Country:US
Practice Address - Phone:586-323-2020
Practice Address - Fax:586-323-4145
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-08
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5847152W00000X
KY1773DT152W00000X
OHT2761152W00000X
MI4901004563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN26930195Medicare PIN