Provider Demographics
NPI:1649685488
Name:ANJI BRASSFIELD O.D. P.C.
Entity type:Organization
Organization Name:ANJI BRASSFIELD O.D. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:ANJANETTE
Authorized Official - Last Name:BRASSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:918-251-3937
Mailing Address - Street 1:307 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-6448
Mailing Address - Country:US
Mailing Address - Phone:918-251-3937
Mailing Address - Fax:918-258-3937
Practice Address - Street 1:307 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-6448
Practice Address - Country:US
Practice Address - Phone:918-251-3937
Practice Address - Fax:918-258-3937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty