Basic Information
| Provider Information | |||||||||
| NPI: | 1154353746 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRAXTON | ||||||||
| FirstName: | DONALD | ||||||||
| MiddleName: | EUGENE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 311619 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 311311619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708521002 | ||||||||
| FaxNumber: | 7709479893 | ||||||||
| Practice Location | |||||||||
| Address1: | 2451 CUMBERLAND PKWY SE | ||||||||
| Address2: | STE. 3138 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303396136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708521002 | ||||||||
| FaxNumber: | 7709479893 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT001375 | GA | X | Eye and Vision Services Providers | Optometrist | 152WC0802X | OPT001375 | GA | X | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.