Provider Demographics
NPI:1912930173
Name:BRAUCH, ERIC CHRISTIAN (OD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CHRISTIAN
Last Name:BRAUCH
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 1:3805 W 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7004
Mailing Address - Country:US
Mailing Address - Phone:305-898-1930
Mailing Address - Fax:305-821-3159
Practice Address - Street 1:3805 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7004
Practice Address - Country:US
Practice Address - Phone:305-898-1930
Practice Address - Fax:305-821-3159
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20911Medicare ID - Type UnspecifiedMEDICARE PART B