Provider Demographics
NPI:1639520141
Name:BRATEK, KRISTIN (OD)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:
Last Name:BRATEK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44344 DEQUINDRE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314-1038
Mailing Address - Country:US
Mailing Address - Phone:586-884-5160
Mailing Address - Fax:
Practice Address - Street 1:44344 DEQUINDRE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314-1038
Practice Address - Country:US
Practice Address - Phone:586-884-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist