Provider Demographics
NPI:1396895025
Name:REMBLESKI, BRADY P (OD)
Entity type:Individual
Prefix:DR
First Name:BRADY
Middle Name:P
Last Name:REMBLESKI
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 1:1315 ALHAMBRA BLVD
Mailing Address - Street 2:STE 310
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816
Mailing Address - Country:US
Mailing Address - Phone:916-452-2020
Mailing Address - Fax:916-452-3365
Practice Address - Street 1:1315 ALHAMBRA BLVD
Practice Address - Street 2:STE 310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-452-2020
Practice Address - Fax:916-452-3365
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11947T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U91519Medicare UPIN