Provider Demographics
NPI:1245365519
Name:BRAUN, JOSEPH WALLACE (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:WALLACE
Last Name:BRAUN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 30027
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-3000
Mailing Address - Country:US
Mailing Address - Phone:509-482-0217
Mailing Address - Fax:509-489-9197
Practice Address - Street 1:4750 N DIVISION ST STE 126
Practice Address - Street 2:NORTHTOWN VISION CLINIC
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1406
Practice Address - Country:US
Practice Address - Phone:509-482-0217
Practice Address - Fax:509-489-9197
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA1815152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
U01636Medicare UPIN