Provider Demographics
NPI:1982617379
Name:BRAJDIC, EDWARD T (OD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:T
Last Name:BRAJDIC
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 1:1225 S MAIN ST
Mailing Address - Street 2:SUITE 403
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-5370
Mailing Address - Country:US
Mailing Address - Phone:724-838-7361
Mailing Address - Fax:724-838-7362
Practice Address - Street 1:1225 S MAIN ST
Practice Address - Street 2:SUITE 403
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-5370
Practice Address - Country:US
Practice Address - Phone:724-838-7361
Practice Address - Fax:724-838-7362
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-000661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
49795OtherDAVIS VISION
PAOEG-000661OtherOPTOMETRY LICENSE NO.
301437OtherNVA
T30344OtherHEALTH AMERICA
PA0009041800001Medicaid
PA424494OtherHIGHMARK BLUE SHIELD
77790OtherAETNA
810224OtherEYEMED
910224OtherEYEMED-2ND LOCATION
PA301437OtherUPMC HEALTH PLAN
PA301437OtherUPMC HEALTH PLAN
PA0277630001Medicare NSC
810224OtherEYEMED
PA424494Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER