Brakefield, Charles Timothy

Brakefield, Charles Timothy is an sole proprietor health care provider with primary practice located at 6401 Odana Rd Ste 23 , Madison WI 53719-1126. He recently has only one registered license in Eye and Vision Services Providers / Ocularist, which is considered as his primary health care specialty. Brakefield, Charles Timothy can be contacted via phone (608) 661-9030.

Contact Information

Primary practice address
6401 Odana Rd Ste 23 Madison WI 53719-1126
Phone: (608) 661-9030
Fax: (608) 661-9040
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Ocularist 156FX1700X 036-0002195093-04 Wisconsin

Profile Details

NPI number 1457894404
LBN Legal business name Brakefield, Charles Timothy
Credentials OCULARIST
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 23rd, 2016
Last updated Jul 21st, 2022 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1457894404 NPPES
Wisconsin MEDICAID 41744100
Wisconsin Other 0829340001

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