Provider Demographics
NPI:1265516074
Name:BRASE, SCOTT W (OD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:BRASE
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 1:164 WINSLOW WAY W
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2512
Mailing Address - Country:US
Mailing Address - Phone:206-842-2015
Mailing Address - Fax:206-842-3047
Practice Address - Street 1:164 WINSLOW WAY W
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2512
Practice Address - Country:US
Practice Address - Phone:206-842-2015
Practice Address - Fax:206-842-3047
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist