Provider Demographics
NPI:1780106427
Name:SPICER, BRAYDON EARL (OD,)
Entity type:Individual
Prefix:DR
First Name:BRAYDON
Middle Name:EARL
Last Name:SPICER
Suffix:
Gender:M
Credentials:OD,
Other - Prefix:DR
Other - First Name:BRAYDON
Other - Middle Name:EARL
Other - Last Name:SPICER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4899 GRIGGS RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77021-2855
Mailing Address - Country:US
Mailing Address - Phone:713-748-5000
Mailing Address - Fax:713-748-8707
Practice Address - Street 1:4899 GRIGGS RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2855
Practice Address - Country:US
Practice Address - Phone:713-748-5000
Practice Address - Fax:713-748-8707
Is Sole Proprietor?:No
Enumeration Date:2017-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9149T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX$$$$$$$$$Medicaid