Basic Information
| Provider Information | |||||||||
| NPI: | 1710970165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRIGMAN | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3901 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103952772 | ||||||||
| FaxNumber: | 9107944131 | ||||||||
| Practice Location | |||||||||
| Address1: | 3901 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | WILMINGTON | ||||||||
| State: | NC | ||||||||
| PostalCode: | 284036733 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103952772 | ||||||||
| FaxNumber: | 9107944131 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 09/14/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1941 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 093RT | 01 | NC | BCBSNC PIN | OTHER | 89093RT | 05 | NC | MEDICAID |